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Interactions of Diarrhea and Malnutrition

Mechanisms and Interventions
  • Lincoln C. Chen

Abstract

The diarrheal diseases are a major cause of death in all poor societies. Typically, these populations have a youthful age structure, with nearly half under 15 years of age and one-sixth under age 5.1 Yet over half of all deaths occur in children under 5 years, the age group at highest risk for diarrhea and malnutrition.2,3 In Latin America, for example, diarrhea was found to be by far the major infectious cause of death in children below age 5, and malnutrition was noted to be a direct or underlying cause of most deaths.3 In-depth longitudinal surveillance in rural Bangladesh has shown diarrhea to be responsible for 28.6% of all deaths in children under 5. Diarrhea accounted for 13.7% of all infant deaths, while among children 1 to 4 years of age, diarrhea was responsible for 44%.2

Keywords

Diarrheal Disease Acute Diarrhea Childhood Diarrhea Tropical Sprue Cholera Vaccine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    United Nations. World Population and Its Age-Sex Composition by Country, 1950–2000: Demographic Estimation and Projection as Assessed in 1978. Population Division, Department of International Economic and Social Affairs, United Nations, New York, January 1980.Google Scholar
  2. 2.
    Chen, L. C., Rahaman, M., and Sarder, A. M. Epidemiology and causes of death among children in a rural area of Bangladesh. Int. J. Epidemiol. 9:25–33, 1980.CrossRefGoogle Scholar
  3. 3.
    Puffer, R. R., and Serrano, C. V. Patterns of Mortality in Childhood, Sci. Public. No. 262. Pan American Health Organization, Washington, D.C. 1973.Google Scholar
  4. 4.
    Mata, L. J. The Children of Santa María Cauqué: A Prospective Field Study of Health and Growth. M.I.T. Press, Cambridge, Massachusetts, and London, England, 1978.Google Scholar
  5. 5.
    Mata, L. J., Urrutia, J. J., and Gordon, J. E. Diarrhoeal disease in a cohort of Guatemalan village children observed from birth to age 2 years. Trop. Geogr. Med. 19:247–257, 1967.Google Scholar
  6. 6.
    Rohde, J. E. Preparing for the next round: Convalescent care after acute infection. Am. J. Clin. Nutr. 31:2258, 1978.Google Scholar
  7. 7.
    Rohde, J. E., and Northrup, R. E. Taking science where the diarrhea is in acute diarrhea in childhood. CIBA Foundation Symposium 42. Elsevier/Excerpta Medica, Amsterdam, 1976.Google Scholar
  8. 8.
    Fox, J. P., Hall, C.E., Cooney, M. K., Luce, R. E., and Kronmal, R. A. The Seattle virus watch. II. Objectives, study population and its observation, data processing and summary of illnesses. Am. J. Epidemiol. 96:270–285, 1972.Google Scholar
  9. 9.
    Scrimshaw, N. S., Taylor, C. E., and Gordon, J. E. Interactions of Nutrition and Infection, World Health Organization Monograph Series No. 57. WHO, Geneva, 1968.Google Scholar
  10. 10.
    Annual Report, 1979. International Centre for Diarrhoeal Disease Research, Bangladesh, Dacca, 1980.Google Scholar
  11. 11.
    Martorell, R., Habicht, J. P., Yarbrough, C., Lechtig, A., Klein, R. E., and Western, K. A. Acute morbidity and physical growth in rural Guatemalan children. Am. J. Dis. Child. 129:1296, 1975.Google Scholar
  12. 12.
    Mata, L. J., Urrutia, J. J., Albertazzi, C., Pellecer, O., and Arellano, E. Influence of recurrent infections on nutrition and growth of children in Guatemala. Am. J. Clin. Nutr. 25:1267–1275, 1972.Google Scholar
  13. 13.
    Rowland, M. G. M., Cole, T. J., and Whitehead, R. G. A quantitative study into the role of infection in determining nutritional status in Gambian village children. Br. J. Nutr. 37:441–450, 1977.CrossRefGoogle Scholar
  14. 14.
    Black, R. E., Huq, I., Merson, M. H., Alim, A. R. M. A., and Yunus, M. Incidence and severity of rotavirus and Escherichia coli diarrhea in rural Bangladesh: Implications for vaccine development. Lancet 1:141–142, 1981.CrossRefGoogle Scholar
  15. 15.
    Black, R. E., Merson, M. H., Rahman, A. S. M. M., Yunus, M., Alim, A. R. M. A., Huq, I., Yolken, R. H., and Curlin, G. T. A two year study of bacterial, viral, and parasitic agents associated with diarrhea in rural Bangladesh. J. Infect. Dis. 142:660–664, 1980.CrossRefGoogle Scholar
  16. 16.
    Barua, D., and Burrows, W. (Eds.). Cholera. W.B. Saunders, Philadelphia, 1974.Google Scholar
  17. 17.
    Mosley, W. H. Biological contamination of the environment by man. Paper presented at the IUSSP Seminar on Biological and Social Aspects of Mortality and Length of Life, Fuiggi, Terme, Italy, May 13–16, 1980.Google Scholar
  18. 18.
    Tallett, S., MacKenzie, C., Middleton, P., Keraner, B., and Hamilton, R. Clinical, laboratory, and epidemilogic features of a viral gastroenteritis in infants and children. Pediatrics 60:217–222, 1977.Google Scholar
  19. 19.
    Field, M. Mechanisms of action of cholera and Escherichia coli enterotoxins. Am. J. Clin. Nutr. 32:189–196, 1979.Google Scholar
  20. 20.
    Guerrant, R. L., Moore, R. A., Kirschenfeld, P. M., and Sande, M. A. Role of toxigenic and invasive bacteria in acute diarrhea of childhood. N Engl. J. Med 293:567–573, 1975.CrossRefGoogle Scholar
  21. 21.
    Field, M., Fromm, D., Al-Awqati, A., and Greenough, W. B. Effect of cholera enterotoxin on ion transport across isolated ileal mucosa. J. Clin. Invest. 51:796, 1972.CrossRefGoogle Scholar
  22. 22.
    Dupont, H. L. Pathogenesis of enteric diarrhea and gut immune mechanisms in defense against enteric infection. In: Proceedings of the XIV International Congress of Pediatrics, Buenos Aires, Argentina, October 1974, p. 96.Google Scholar
  23. 23.
    Levine, M. M., DuPont, H. L., Formal, S., Hornick, R. B., Takeuchi, A., Gangarosa, E. J., Snyder, M. J., and Libonati, J. P. Pathogenesis of Shigella dysenteriae I (Shiga) dysentery. J. Infect. Dis. 127:261, 1973.CrossRefGoogle Scholar
  24. 24.
    Hughes, J. M., Murad, F., Chang, B., and Guerrant, R. L. Role of cyclic GMP in the action of heat-stable enterotoxin of Escherichia coli. Nature 271:755, 1978.CrossRefGoogle Scholar
  25. 25.
    Rodriquez, W. J., Kim, H. W., Arrobio, J. O., Brandt, C. D., Chanock, R. M., Zapikian, A. Z., Wyall, R. G., and Parrott, R. H. Clinical features of acute gastroenteritis associated with human reovirus-like agent in infants and young children. J. Pediatr. 91: 188–193, 1977.CrossRefGoogle Scholar
  26. 26.
    Sack, D. A., Rhoads, M., Molla, A., Molla, A. M., and Wahed, M. A. The role of carbohydrate malabsorption in determining the severity of rotavirus diarrhea. International Centre for Diarrhoeal Disease Research, Bangladesh, 1981.Google Scholar
  27. 27.
    Keusch, G. T., Grady, G. F., Mata, L. J., and McIver, J. The pathogenesis of Shigella diarrhea. I. Enterotoxin production by Shigella dysenteriae 1. J. Clin. Invest. 51:1212, 1972.CrossRefGoogle Scholar
  28. 28.
    Creed, H. M., and Graham, G. G. Determinants of growth among poor children. I. Food and nutrient intake. Am. J. Clin. Nutr. 33:715–722, 1980.Google Scholar
  29. 29.
    Hirschhorn, N., and Denny, K. M. Oral glucose-electrolyte therapy for diarrhea: A means to maintain or improve nutrition? Am. J. Clin. Nutri. 28:189, 1975.Google Scholar
  30. 30.
    Hoyle, B., Yunus, M., and Chen, L. C. Breast-feeding and food intake among children with acute diarrheal disease. Am. J. Clin. Nutr. 33:2365–2371, 1980.Google Scholar
  31. 31.
    Martorell, R., Yarbrough, C., Yarbrough, S., and Klein, R. E. The impact of ordinary illnesses on the dietary intakes of malnourished children. Am. J. Clin. Nutr. 33:345–350, 1980.Google Scholar
  32. 32.
    Mata, L. J., Kronmal, R. A., Urrutia, J. J., and Garcia, B. Effect of infection on food intake and nutritional state: Perspectives as viewed from the village. Am. J. Clin. Nutr. 30:1215, 1977.Google Scholar
  33. 33.
    Murray, M. J., and Murray, A. B. Anorexia of infection as a mechanism of host defense. Am. J. Clin. Nutr. 32:593–596, 1979.Google Scholar
  34. 34.
    Einstein, L. P., McKay, D. M., and Rosenberg, I. H. Pediatric xylose malabsorption in East Pakistan: Correlation with age, growth retardation, and weanling diarrhea. Am. J. Clin. Nutr. 25:1230, 1972.Google Scholar
  35. 35.
    Lindenbaum, J. Malabsorption during and after recovery from acute intestinal infection. Br. Med. J. 2:326, 1965.CrossRefGoogle Scholar
  36. 36.
    Rosenberg, I. H., and Scrimshaw, N. S. (Eds.). Workshop on malabsorption and nutrition, Parts I and II. Am. J. Clin. Nutr. 25:1046; 1226, 1972.Google Scholar
  37. 37.
    Rosenberg, I. H., Solomons, N. W., and Schneider, R. E. Malabsorption associated with diarrhea and intestinal infections. Am. J. Clin. Nutr. 30:1248–1253, 1977.Google Scholar
  38. 38.
    Brown, K. H., Parry, L., Khatum, M., and Ahmed, M. G. Lactose malabsorption in Bangladeshi children: Relation with age, history of recent diarrhea, nutritional status, and breast-feeding. Am. J. Clin. Nutr. 32:1962–1969, 1979.Google Scholar
  39. 39.
    Hirschhorn, N., Molla, A., and Molla, A. M. Reversible jejunal disaccharidase deficiency in cholera and other acute diarrheal diseases. Johns Hopkins Med. J. 125:291–300, 1969.Google Scholar
  40. 40.
    Rosensweig, N. S. Diet and intestinal enzyme adaptation: Implications for gastrointestinal disorders. Am. J. Clin. Nutr. 28:648–655, 1975.Google Scholar
  41. 41.
    Chung, A. The effect of oral feeding at different levels on the absorption of foodstuffs in infantile diarrhea. J. Pediatr. 33:1–13, 1948.CrossRefGoogle Scholar
  42. 42.
    Chung, A., and Viščorová, B. The effect of early oral feeding versus early oral starvation on the course of infantile diarrhea. J. Pediatr. 33:14–22, 1948.CrossRefGoogle Scholar
  43. 43.
    Beisel, W. R. Metabolic response to infection. Ann. Rev. Med. 26:9, 1975.CrossRefGoogle Scholar
  44. 44.
    Beisel, W. R. Nutrient wastage during infection. In: Proceedings of the Ninth International Congress of Nutrition 2:160, 1970.Google Scholar
  45. 45.
    Beisel, W. R., Sawyer, W. D., Ryll, E. D., and Crozier, D. Metabolic effects of intracellular infections in man. Ann. Intern. Med. 67:744, 1967.Google Scholar
  46. 46.
    Briscoe, J. The quantitative effect of infection on the use of food by young children in poor countries. Am. J. Clin. Nutr. 32:648, 1979.Google Scholar
  47. 47.
    Feigin, R. D. Interaction of nutrition and infection: Plans for future research. Am. J. Clin. Nutr. 30:1553, 1977.Google Scholar
  48. 48.
    Pollack, H., and Sheldon, D. R. The factor of disease in the world food problem. J. Am. Med. Assoc. 212:598, 1970.CrossRefGoogle Scholar
  49. 49.
    Powanda, M. C. Changes in body balances of nitrogen and other key nutrients: Description and underlying mechanisms. Am. J. Clin. Nutr. 30:1254–1268, 1977.Google Scholar
  50. 50.
    Scrimshaw, N. S. Effect of infection on nutrient requirements. Am. J. Clin. Nutr. 30:1536–1544, 1977.Google Scholar
  51. 51.
    Keusch, G. T. The consequences of fever. Am. f. Clin. Nutr. 30:1211–1214, 1977.Google Scholar
  52. 52.
    Dossetor, J. F. B., and Whittle, H. C. Protein-losing enteropathy and malabsorption in acute measles enteritis. Br. Med. J. 2:592, 1975.CrossRefGoogle Scholar
  53. 53.
    Spira, W. M., Saeed, Y. A., Khan, M. V., and Satar, M. A. Microbiological surveillance of intra-neighborhood E1 Tor cholera transmission in rural Bangladesh. Bull WHO 58:731–740, 1980.Google Scholar
  54. 54.
    White, G. F., Bradley, D. J., and White, A. V. Drawers of Water: Domestic Water Use in East Africa. University of Chicago Press, Chicago, 1972.Google Scholar
  55. 55.
    Palmer, D. L., Koster, F. T., Alam, A. K. M. J., and Islam, M. R. Nutritional status: A determinant of severity of diarrhea in patients with cholera. J. Infect. Dis. 134:8, 1976.CrossRefGoogle Scholar
  56. 56.
    Koster, F. T., Aziz, K. M. A., Haque, A., and Curlin, G. T. Measles in Bangladesh: Synergy between measles, diarrhea, and malnutrition. In press, 1981.Google Scholar
  57. 57.
    Cash, R. A., Nalin, D. R., Rochat, R., Relier, L.B., Haque, Z. A., and Rahaman, A. S. M. M. A clinical trial of oral therapy in a rural cholera treatment center. Am. J. Trop Med. Hyg. 19:653, 1970.Google Scholar
  58. 58.
    Mahalanabis, D., Wallace, C. K., Kallen, R. J., Mondai, A., and Pierce, N. F. Water and electrolyte losses due to cholera in infants and children: A recovery balance study. Pediatrics 45:374–385, 1970.Google Scholar
  59. 59.
    Kielmann, A. A., and McCord, C. Home treatment of childhood diarrhea in Punjab villages. J. Trop. Pediatr. Environ. Child Health 23:195, 1977.Google Scholar
  60. 60.
    Mahalanabis, D., Choudhuri, A. B., Bagchi, N. G., Battacharya, A. K., and Simpson, T. W. Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med. J. 132:197, 1973.Google Scholar
  61. 61.
    Morley, D. Paediatric Priorities in the Developing World. Butterworths, London, 1973.Google Scholar
  62. 62.
    Nalin, D. R., Cash, R. A., and Rahaman, A. S. M. M. Oral (or nasogastric) maintenance therapy for cholera patients in all age groups. Bull. WHO 43:361, 1970.Google Scholar
  63. 63.
    Walsh, J. A., and Warren, K. S. Selective primary health care: An interim strategy for disease control in developing countries. N. Engl. J. Med. 301:967–974, 1979.CrossRefGoogle Scholar
  64. 64.
    Lindenbaum, J., Greenough, W. B., and Islam, M. R. Antibiotic therapy of cholera in children. Bull. WHO 37:529, 1967.Google Scholar
  65. 65.
    Blackburn, G. F., Flatt, J. P., Clowes, G. H. A., O’Donnell, T. F., and Hensle, T. E. Protein-sparing therapy during periods of starvation with sepsis or trauma. Ann. Surg. 177:588–594, 1973.CrossRefGoogle Scholar
  66. 66.
    Lifshitz, F., Coelle-Ramirez, R., and Contreras-Gutierrez, M. L. The response of infants to carbohydrate oral loads after recovery from diarrhea. J. Pediatr. 79:612, 1971.CrossRefGoogle Scholar
  67. 67.
    Lugo-de-Rivera, C., Rodriguez, H., and Torres-Pinedo, R. Studies on the mechanism of sugar malabsorption in infantile infectious diarrhea. Am. J. Clin. Nutr. 25:1248–1253, 1972.Google Scholar
  68. 68.
    Whitehead, R. G. Protein and energy requirements of young children living in the developing countries to allow for catch-up growth after infections. Am. J. Clin. Nutr. 30:1545–1547, 1977.Google Scholar
  69. 69.
    World Health Organization. Energy and Protein Requirements, Report of an FAO/WHO Ad Hoc Expert Committee, WHO Tech. Rep. Ser. No. 522. WHO Geneva, 1973.Google Scholar
  70. 70.
    Merson, M. H., Sack, R. B., Kibria, A. K. M. G., Mahmood, A., Adamed, O. S., and Huq, I. The use of colony pools for diagnosis of enterotoxigenic Escherichia coli diarrhea. J. Clin. Microbiol. 9:493–497, 1979.Google Scholar
  71. 71.
    Yolken, R. H., Wyatt, R. G., and Kapikian, A. Z. ELISA for rotavirus. Lancet ii:819, 1977.CrossRefGoogle Scholar
  72. 72.
    Sack, D. A., Chowdhury, A. M. A. K., Eusof, A., Ali, M. A., Merson, M. H., Islam, S., Black, R. E., and Brown, K. H. Rehydration in rotavirus diarrhea: A double blind comparison of sucrose with glucose electrolyte solution. Lancet ii:280–284, 1978.CrossRefGoogle Scholar
  73. 73.
    Blacklow, N. R., Dolin R., Fedson, D. S., DuPont, H., Northrup, R. S., Hornick, R. B., and Chansck, R. M. Acute infectious non-bacterial gastroenteritis: Etiology and pathogenesis. Ann. Intern. Med. 76:993, 1972.Google Scholar
  74. 74.
    Keusch, G. T. Subclinical malabsorption in Thailand. I. Intestinal absorption in Thai children. Am. J. Clin. Nutr. 25:1062–1066, 1972.Google Scholar
  75. 75.
    Klipstein, F. A., and Corcino, J. J. Factors responsible for weight loss in tropical sprue. Am. J. Clin. Nutr. 30:1703–1708, 1977.Google Scholar
  76. 76.
    Baker, S. J., and Mathan, V. I. Tropical enteropathy and tropical sprue. Am. J. Clin. Nutr. 25:1047–1055, 1972.Google Scholar
  77. 77.
    Ashworth, A. Growth rates in children recovering from protein-calorie malnutrition. Br. J. Nutr. 23:835, 1969.CrossRefGoogle Scholar
  78. 78.
    Ashworth, A., Bell, R., James, W. P. T., and Waterlow, J. C. Calorie requirements of children recovering from protein-calorie malnutrition. Lancet ii:600, 1968.CrossRefGoogle Scholar
  79. 79.
    Chandra, R. K. Immunological aspects of human milk. Nutr. Rev. 36:265–272, 1978.CrossRefGoogle Scholar
  80. 80.
    World Health Organization. Report of a field trial by an international study group. A positive effect on the nutrition of Philippine children of an oral glucose-electrolyte solution given at home for the treatment of diarrhea. Bull. WHO 55:87, 1977.Google Scholar

Copyright information

© The United Nations University 1983

Authors and Affiliations

  • Lincoln C. Chen
    • 1
  1. 1.New Delhi Field OfficeThe Ford FoundationNew DelhiIndia

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