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

Ramendra N. Mazumder, Hassan Ashraf, Syed S. Hoque, Iqbal Kabir, Naseha Majid, Mohammad A. Wahed, George J. Fuchs, Dilip Mahalanabis

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)775-779
Number of pages5
JournalBritish Journal of Nutrition
Volume84
Issue number5
DOIs
StatePublished - 2000

Bibliographical note

Funding Information:
This research was supported by Swiss Development Co-operation and the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B): Centre for Health and Population Research. The ICDDR, B is supported by countries and agencies which share its concern for the health problems of developing countries. Current donors include: the aid agencies of the governments of Australia, Bangladesh, Belgium, Canada, China, Denmark, Germany, Japan, the Netherlands, Norway, Republic of Korea, Saudi Arabia, Sweden, Switzerland, the UK and the USA; international organisations including the Arab Gulf Fund, Asian Development Bank, International Atomic Energy Centre, the United Nations International Children's Emergency Fund (UNICEF), the United Nations Development Program (UNDP), the United Nations Population Fund (UNFPA) and the World Health Organization (WHO); private foundations including Child Health Foundation, Ford Foundation, Population Council, Rockefeller Foundation and the Sasakawa Foundation; and private organisations including American Express Bank, Bayer A.G., CARE, Family Health International, Helen Keller International, the Johns Hopkins University, Macro International, New England Medical Center, Procter Gamble, RAND Corporation, SANDOZ, Swiss Red Cross and the University of Alabama at Birmingham, AL, USA, the University of Iowa Ames, IA, USA, and others.

Funding

This research was supported by Swiss Development Co-operation and the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B): Centre for Health and Population Research. The ICDDR, B is supported by countries and agencies which share its concern for the health problems of developing countries. Current donors include: the aid agencies of the governments of Australia, Bangladesh, Belgium, Canada, China, Denmark, Germany, Japan, the Netherlands, Norway, Republic of Korea, Saudi Arabia, Sweden, Switzerland, the UK and the USA; international organisations including the Arab Gulf Fund, Asian Development Bank, International Atomic Energy Centre, the United Nations International Children's Emergency Fund (UNICEF), the United Nations Development Program (UNDP), the United Nations Population Fund (UNFPA) and the World Health Organization (WHO); private foundations including Child Health Foundation, Ford Foundation, Population Council, Rockefeller Foundation and the Sasakawa Foundation; and private organisations including American Express Bank, Bayer A.G., CARE, Family Health International, Helen Keller International, the Johns Hopkins University, Macro International, New England Medical Center, Procter Gamble, RAND Corporation, SANDOZ, Swiss Red Cross and the University of Alabama at Birmingham, AL, USA, the University of Iowa Ames, IA, USA, and others.

FundersFunder number
American Express Bank
Arab Gulf Fund
ICDDR, B Centre for Health and Population Research
Helen Keller International
International Atomic Energy Centre
Great Britain Sasakawa Foundation
Swiss Red Cross
United Nations International Children's Emergency Fund
University of Iowa Ames
Ford Foundation
Rockefeller Foundation, The
UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust
Bayer AG
Proctor and Gamble
World Health Organization
Asian Development Bank Philippines
RAND Corporation
Population Council
United Nations Population Fund
New England Medical Center
The Johns Hopkins University
FHI 360
Sandoz
University of Alabama
United Nations Development Programme
Andy Hill CARE Fund
International Centre for Diarrhoeal Disease Research Bangladesh

    ASJC Scopus subject areas

    • Medicine (miscellaneous)
    • Nutrition and Dietetics

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