Recent developments in the nutritional management of diarrhoea. 3. Practical approaches towards dietary management of acute diarrhoea in developing communities
Torún, B.; Chew, F.
Transactions of the Royal Society of Tropical Medicine and Hygiene 85(1): 12-17
1991
ISSN/ISBN: 0035-9203 PMID: 2068740 DOI: 10.1016/0035-9203(91)90138-oDocument Number: 363454
Diarrhoeal diseases account (both directly and indirectly) for a great deal of malnutrition, especially in children in developing countries. Faecal loss of incompletely absorbed nutrients, and a reduction in food intake are both involved; anorexia and "inadequate dietary practices" contribute to the latter. Regrettably, "withholding food during the early stages of acute diarrhoea and substitution of nutritious foods with dilute preparations of low nutritional value are still common practices", and this misconception (which exacerbates small intestinal injury) is common among not only the general population but also medical personnel. The authors of this review article summarize the many causes of inadequate feeding practices. Despite a relative decline in brush-border lactase concentration in acute diarrhoeal disease, "most children tolerate significant amounts of milk". Widespread fears exist that certain foodstuffs (e.g. those high in fibre-content) may exacerbate diarrhoea. Certain diets which are commonly (but wrongly) recommended during a diarrhoeal episode are expensive and therefore beyond the reach of many individuals in developing countries.In practice, breastfeeding should not be interrupted during a diarrhoeal attack (it has a curative effect); when cow's milk is used, it should be continued at full-strength (dilution should be avoided) during the period of disease, and convalescence also. Several diets based on local staples are "excellent choices" for the dietary management of diarrhoea; for example, in Guatemala, an all-vegetable diet has been shown to produce a sharp decrease (reduction by two-thirds when compared with a mixed animal-vegetable diet) in the duration of acute diarrhoea. The all-vegetable diet consisted of incaparina gruel (58% corn flour, 38% cottonseed flour, 4% lysine, vitamin and mineral mix) with 5% sugar and a pap with 5.6% rice, 7% corn, 2.5% black beans (Phaseolus vulgaris), 2.5% vegetable oil and 9% sugar; its macronutrients are reasonably well absorbed. Although anorexia may be present, most children will eat palatable foods, which should be offered frequently and patiently.The authors of this valuable review, on a crucially important subject, conclude with a most useful list of 13 recommendations on dietary practices throughout episodes of acute diarrhoeal disease and during convalescence.G.C. Cook A review. Diarrhoeal diseases are a major cause of malnutrition, partly due to poor dietary practices. Misconceptions among the general population and medical personnel lead to withholding of food or avoiding the use of nutritious, locally available and affordable foods. Breast feeding should not be interrupted during diarrhoea. Many recent studies have shown that when cow milk is used, full-strength milk should be fed throughout the disease and in convalescence. The concept of diluting milk with water should be avoided. If necessary, full-strength milk should be mixed with equal amounts of other foods. Other recent studies have shown that several diets based on local staples are excellent choices for the dietary management of diarrhoea. An all-vegetable diet commonly eaten in Guatemala produced a sharp decrease in the duration of acute diarrhoea (median duration after feeding began, 1.8 days) and its macronutrients were reasonably well absorbed. Practical recommendations are given, including nutritional, physiological, cultural and economic considerations.
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