Effects of a Protein-Rich Diet during Convalescence from Shigellosis on Catch-up Growth, Serum Proteins, and Insulin-Like, Growth Factor-I

Abstract

ABSTRACT. Shigellosis in children can cause growth retardation, worsening of malnutrition, and hypoproteinemia. To assess the effects of ingestion of a protein-rich diet during convalescence, 22 children aged 2 to 4 y with culture-proven shigellosis were randomly assigned after 5 d of antibiotic treatment to 21-d feeding regimens of either a 150 kcal/kg/d high-protein diet with 15% of calories as protein or an isocaloric control diet with 6% of calories as protein. At the start and end of dietary treatment, weight, height, mid-arm circumference, skinfold thickness, serum protein concentrations, and serum IGF-I were measured. Means of weight gain and increases in mid-arm circumference were greater in children fed high-protein diets than those fed control diets (1.23 versus 0.76 kg; 1.40 versus 0.96 cm; p < 0.05). Mean increase in height in children fed high-protein diets (0.83 cm) was not significantly greater than with control diets (0.74 cm). Mean increases in serum concentrations of total protein, prealbumin, and retinol-binding protein were greater in the high-protein group than in controls ( p < 0.05). Mean serum concentrations of IGF-I were low in both groups before treatment [4.2 f 2.6 nmol/L (31.9 f 19.6 ng/mL) in controls; 3.1 f 3.4 nmol/L (24.0 f 26.3 ng/mL) in the high-protein group] but increased more in the high-protein group 139.0 f 16.2 nmol/L (298 f 124 ng/mL)] than in the control group 116.7 f 9.2 nmol/L (128 f 70 ng/mL), p < 0.011. These results suggest that high dietary protein is more effective than a normal protein intake in repleting body proteins and in stimulating growth after shigellosis in children. A possible mechanism for this stirnulatory effect on growth may be through the restoration of IGF-I. The World Health Organization advised continued breastfeeding and feeding of weaning diets during diarrhea (3). These recommendations apply mainly to watery diarrheas affecting the small intestine, and less attention has been given to shigellosis and other infections affecting the colon (4). Furthermore, no recommendations are available regarding feeding during the recovery period.Catch-up of lost growth is desirable during and after acute infections. Whitehead ( 5 ) calculated that a 7-kg child needs 25% more calories for catch-up growth than for normal growth (about 150 kcal/kg/d), and the percentage of calories supplied as protein needs to be nearly doubled (to more than 1 1 %). The duration of intensive feeding needed for growth catch-up was estimated to be about three times longer than the preceding acute disease, because the anabolic phase of recovery is assumed to last three times longer than the catabolic phase of disease (I).In addition to growth impairment, infections and malnutrition lead to reductions in serum protein concentration. In Bangladesh, serum protein concentrations in children with severe shigellosis are about half of the normal values (6). Diets with higher protein content may have a beneficial effect to increase the rate of albumin synthesis, thus raising the serum alb...

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