3. Practical approaches towards dietary management of acute diarrhoea in developing communities

Abstract

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's milk is used, full-strength milk should be fed throughout the disease and in convalescence. The concept of diluting milk with water should be altogether 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 d) and its macronutrients were reasonably well absorbed. Practical recommendations are given, including nutritional, physiological, cultural and economic considerations.

Dietary management of acute diarrhea with local foods in a Guatemalan rural community

“…This is the first study to document the reduction of diarrhea duration in a community setting with the addition to the home diet of other locally available, culturally acceptable foods, in comparison with the intake of only the childrens' habitual diet. This result is consistent with a controlled clinical trial performed by our group with hospitalized children in Guatemala city using a similar gruel and a maize-black beans-rice-oilsugar pap, compared with lactose-hydrolysed milk and a rice-egg-oatmeal-oil-sugar pap (8,18). In that study, median durations of diarrhea were 1.8 and 5.3 d with the all-vegetable and the milk-pap diets, respectively.…”

“…Clinic-based studies of early or continued feeding with formula and milks during acute diarrhea have been shown to lead to better weight gains relative to late or restricted feeding (3)(4)(5)(6). Clinic-based research on the use of locally available, plant-derived foods have found that these foods shorten the diarrhea episode when compared to milk or formula diets (7)(8)(9)(10). International health organizations actively promote continued, or increased, feeding of locally available foods during acute diarrhea (1 l), even though very few community-based efficacy trials of this strategy have been performed.…”

Global Nutrition Epidemiology and Trends

“…Possible strategies include promotion of breastfeeding, dietary supplementation of micronutrients, prevention of protein-energy malnutrition as far as possible, and improvement in the standard of preparation and hygiene of available weaning foods [22]. Recent reviews have shown that no breastfeeding led to a 47 and 157% increase in diarrhea-related mortality in 6- to 11- and 12- to 23-month-old children, respectively [23].…”

Alimentación sostenida durante diarrea aguda en niños menores de cinco años

“…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. 6,24,39 En este último aspecto es muy importante que el personal de los servicios de salud esté actualizado respecto a las recomendaciones sobre el manejo nutricio del niño con diarrea, de manera que pueda ofrecer una orientación sólida y convincente. Igualmente importante es que la orientación que la madre reciba en los diferentes niveles de atención sea congruente.…”

“…6 Los efectos deletéreos de la diarrea sobre el estado nutricio del niño se producen por uno o más de los siguientes mecanismos: reducción en la ingestión dietética, [7][8][9][10] absorción disminuida de nutrientes, [11][12][13] aumento del catabolismo, 14 pérdida directa de nutrientes por el intestino 8,15,16 e ineficiencia metabó-lica debida a deficiencias de micronutrientes. [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.…”