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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
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Abstract

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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

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