Malnutrition is a determining factor in diarrheal duration, but not incidence, among young children in a longitudinal study in rural Bangladesh

Abstract

Diarrhea and malnutrition are common in young children in developing countries and a reciprocal relationship has been postulated with diarrhea leading to malnutrition and malnutrition predisposing to diarrhea. To investigate the importance of malnutrition as a determining factor in diarrheal illnesses, data were analyzed from a longitudinal community-based study done in rural Bangladesh. Children classified by nutritional status according to a variety of anthropometric indicators were prospectively evaluated for incidence, duration, and etiology of diarrhea. Children with low weight for length had longer durations of diarrhea than better nourished children; however, children of differing nutritional status had similar diarrheal incidences. The duration of diarrhea, including that associated with enterotoxigenic Escherichia coli and Shigella, increased progressively as nutritional status indicators worsened. These results suggest that nutritional interventions alone are unlikely to reduce the high incidence of diarrhea, but that efforts to improve nutritional status may have a beneficial effect on the duration of diarrhea and its unfavorable nutritional consequences.

Nutritional status of children of urban low-income communities, Brazil (1986)

“…The statistical analysis shown in Table 5 demonstrates that stunting here is not associated with a high incidence of diarrhea, but rather with a prolonged duration of diarrhea. This observation has already been made by Black et al 2 .…”

Undernutrition in relation to childhood infections: a prospective study in the Sudan

“…Stunting and wasting were also associated with the incidence and duration of diarrhoea in a Guatemalan study and an Ethiopian study population (Delgado et al, 1983;Lindtjùrn et al, 1993). Studies among Bangladeshi pre-school children found positive associations between wasting and underweight and the duration but not the incidence of diarrhoea (Black et al, 1984;Bairagi et al, 1987) while another found duration of diarrhoea only to be signi®cantly associated with underweight (Chowdhury et al, 1990). The studies examining associations between undernutrition and infections differed substantially in design and analyses, demographic factors of the study population and adjustments for covariates.…”

“…A study from Nigeria showed that moderate and severe undernutrition were associated with both the incidence and duration of diarrhoeal disease (Tomkins, 1981), while three other studies observed positive associations between undernutrition and the incidence of diarrhoea only (Sepu Âlveda et al, 1988;El-Samani et al, 1988;Lindtjùrn et al, 1993). Yet another three studies found positive associations between severe and moderate undernutrition and the duration or percentage of annual time with diarrhoeal illness, but not the incidence of disease (Trowbridge et al, 1981;Black et al, 1984;Bairagi et al, 1987). In two studies, no associations were observed between nutritional status and the incidence or duration of diarrhocal disease (Chen et al, 1981;Mathur et al, 1985).…”

Epidemiologic evidence for a potentiating effect of malnutrition on child mortality.

“…It is known from epidemiologic studies that malnutrition affects severity of diarrhea much more than it affects incidence of diarrhea. 19 Severity of measles is also markedly affected by malnutrition.20 It is unclear whether this pattern is generalizable to other types of morbidity, and elucidation of the basis for these differential mechanisms would reveal facts ofwider clinical utility. It is also important to note that deficits in the weight-for-age of children may not be caused solely by protein-energy malnutrition but may also arise from associated micronutrient deficiencies.…”