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Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
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OCR for page R1
Nutritional Management of
Acute Diarrhea in
Infants and Children
Subcommittee on Nutrition and
Diarrheal Diseases Control
Committee on I International Nutrition Programs
Food and Nutrition Board
Commission on Life Sciences
National Research Council
NATIONAL ACADEMY PRESS
Washi ngton, D.C. 1985
OCR for page R2
NOTICE: The project that is the subject of this report
was approved by the Governing Board of the National
Research Council, whose members are drawn from the coun-
cils of the National Academy of Sciences, the National
Academy of Engineering, and the Institute of Medicine.
The members of the committee responsible for the report
were chosen for their special competences and with
regard for appropriate balance.
This report has been reviewed by a group other than
the authors according to procedures approved by a Report
Review Committee consisting of members of the National
Academy of Sciences, the National Academy of Engineering,
and the Institute of Medicine.
The National Research Council was established by the
National Academy of Sciences in 1916 to associate the
broad community of science and technology with the
Academy's purposes of furthering knowledge and of
advising the federal government. The Research Council
operates in accordance with general policies determined
by the Academy under the authority of its congressional
charter of 1963, which establishes the Academy as a
private, nonprofit, self-governing membership
corporation. The Research Council has become the
principal operating agency of both the National Academy
of Sciences and the National Academy of Engineering in
the conduct of their services to the government, the
public, and the scientific and engineering communities.
It is administered jointly by both Academies and the
Institute of Medicine. The National Academy of
Engineering and the Institute of Medicine were
established in 1964 and 1970, respectively, under the
charter of the National Academy of Sciences.
The study summarized in this report was supported by
Contract AID-ta-C-1428 and Grant DAN-0262-G-SS-4086-00
from the Agency for International Development.
Copies available from:
Food and Nutrition Board
National Research Council
2101 Constitution Avenue, N.W.
Washington, D.C. 20418
Printed in the United States of America
OCR for page R3
SUBCOMMITTEE ON NUTRITION AND DIARRHEAL DISEASES CONTROL
Richard A. Cash (Chairman), Harvard Institute for
International Development, Cambridge, and Office of
International Health, Harvard School of Public Health,
Boston, Massachusetts
Robert E. Black, Department of International Health,
Johns Hopkins School of Hygiene and Public Health,
Baltimore, Maryland
Kenneth H. Brown, Instituto de Investigacion
Nutricional, Lima, Peru, and Department of
International Health, Johns Hopkins School of Hygiene
and Public Health, Baltimore, Maryland
Cutberto Garza, United States Department of Agriculture
Children's Nutrition Research Center, Department of
Pediatrics, Baylor College of Medicine, Houston, Texas
Gerald Keusch, Division of Geographic Medicine,
Tufts-New England Medical Center, Boston, Massachusetts
Jon Rohde, Management Sciences for Health,
Port-au-Prince, Haiti
W. Allan Walker, Massachusetts General Hospital and
Children's Hospital Medical Center, Boston,
Massachusetts
Linda D. Meyers, Senior Staff Officer
Norman Grossblatt, Editor
OCR for page R4
COMMITTEE ON INTERNATIONAL NUTRITION PROGRAMS
Abraham Horwitz (Chairman), Pan American Health
Organization, Washington, D.C.
Maiden C. Nesheim (Vice-Chairman), Division of
Nutritional Sciences, Cornell University, Ithaca, New
York
William P. Butz, Bureau of the Census, Washington, D.C.
Cutberto Garza, United States Department of Agriculture
Children's Nutrition Research Center, Department of
Pediatrics, Baylor College of Medicine, Houston, Texas
Reynaldo Martorell, Food Research Institute, Stanford
University, Stanford, California
Ellen Messer, International Food and Nutrition Program,
Massachusetts Institute of Technology, Cambridge,
Massachusetts
Per Pinstrup-Andersen, International Food Policy
Research Institute, Washington, D.C.
Jon E. Rohde, Management Sciences for Health,
Port-au-Prince, Haiti
Fernando Viteri, Food and Nutrition Programs, Pan
American Health Organization, Washington, D.C.
Marian Zeitlin, School of Nutrition, Tufts University,
Medford, Massachusetts
Linda D. Meyers-, Senior Staff Officer
— TV
OCR for page R5
FOOD AND NUTRITION BOARD
Kurt J. Isselbacher (Chairman), Massachusetts General
Hospital, Boston, Massachusetts
Richard J. Havel (Co-Vice-Chairman), Cardiovascular
Research Center, University of California School of
Medicine, San Francisco, California
Hamish N. Munro (Co-Vice-Chairman), Human Nutrition
Research Center on Aging, Tufts University, Boston,
Massachusetts
William E. Connor, Department of Medicine, Oregon Health
Sciences University, Portland, Oregon
Peter Greenwald, Division of Cancer Prevention and
Control, National Cancer Institute, National
Institutes of Health, Bethesda, Maryland
M. R. C. Greenwood, Vassar College, Poughkeepsie,
New York
Joan D. Gussow, Department of Nutrition Education,
Teachers College, Columbia University, New York
James R. Kirk, Research and Development, Campbell Soup
Company, Camden, New Jersey
Reynaldo Martorell, Food Research Institute, Stanford
University, Stanford, California
Walter Mertz, Human Nutrition Research Center,
Agricultural Research Service, Department of
Agriculture, Beltsville, Maryland
J. Michael McGinnis, Office of Disease Prevention and
Health Promotion, Department of Health and Human
Services, Washington, D.C.
Maiden C. Nesheim, Division of Nutritional Sciences,
Cornell University,
Ithaca, New York
(continued on next page)
OCR for page R6
FOOD AND NUTRITION BOARD (Continued)
Ronald C. Shank, University of California, Irvine,
California
Robert H. Wasserman, Department/Section of Physiology,
New York State College of Veterinary Medicine, Cornell
University, Ithaca, New York
Myron Winick, Institute of Human Nutrition, Columbia
University, New York
Sushma Palmer
, Executive Director
— vim
OCR for page R7
PREFACE
In October 1983, the Office of Nutrition of the
Agency for International Development (AID) asked the
National Research Council to review nutritional aspects
of acute diarrhea in children and to prepare guidelines
for incorporating nutritional considerations into its
treatment. In response, the Subcommittee on Nutrition
and Diarrheal Diseases Control was established in
September 1984 under the auspices of the Committee on
International Nutrition Programs of the Food and
Nutrition Board in the Research Council's Commission on
Life Sciences. This report presents the results of the
subcommittee's efforts.
The report is written primarily for health profes-
sionals who will be advising on programs and policy
related to nutrition and diarrhea therapy. It is tech-
nical in orientation and, although not a manual itself,
can be used as a guide in preparing manuals, training
courses, public education materials, and communication
strategies directed toward all those responsible for
child care. The message is aimed at management of diar-
rhea in less-developed countries, but the information
and technical insights are relevant to an understanding
of diarrhea and its management throughout the world.
Similarly, although many children in industrialized
countries are better protected from the nutritional
consequences of acute diarrhea, the recommendations in
this report hold equally well for children of all
countries.
The first chapter examines the nutritional conse-
quences of acute diarrhea and the premise that continued
feeding during diarrhea is not generally harmful and
e e
— V11
-
OCR for page R8
indeed can be highly beneficial. Chapter 2 presents
general guidance for nutritional management, including
comments on choice of foods, food preparation, frequency
of feeding, and monitoring of therapy. The chapter also
provides an overview of oral Dehydration therapy, which
is aimed at correcting electrolyte losses and maintain-
ing fluid balance. Chapter 3 outlines research needs
emerging from the subcommittee's literature review, and
Chapter 4 summarizes the subcommittee's major findings.
Two aspects of the diarrhea-nutrition complex are
not covered in this report: the nutritional management
of severe protein-energy malnutrition, including the
diarrhea accompanying it, and the relationship of nutri-
tional state of the child to susceptibility to diarrhea!
and other infections. Both have been extensively
reviewed elsewhere (see, for example Torun and
Viteri 48 and Mata et al.28~.
The subcommittee wishes to thank members of the
Committee on International Nutrition Programs and the
Food and Nutrition Board for their helpful comments on
drafts of the report. The subcommittee also acknowl-
edges the continued interest and support of Martin J.
Foreman and Nicolaas Luykx of the Office of Nutrition,
AID. In addition, the subcommittee is grateful for the
contributions of Sushma Palmer, Executive Director, Food
and Nutrition Board, who reviewed and commented on
drafts; Shirley E. Cole of the Food and Nutrition Board
staff, who provided administrative and secretarial
assistance early in the project; Avis I. Harris, also of
the Food and Nutrition Board staff, who was responsible
for manuscript preparation and for design and layout of
the final report; and Norman Grossblatt, of the
Commission on Life Sciences staff, who edited the report.
Most importantly, the subcommittee wishes to express
its appreciation to Linda D. Meyers, Senior Staff
Officer, Food and Nutrition Board, and convener of the
subcommittee, who worked closely with us throughout the
project. Her contributions were invaluable, and working
with her was a pleasure foretell of us.
Ric rd A. sh
Chairman, Subcommittee on Nutrition
and Diarrheal Diseases Control
. . .
— veal
OCR for page R9
CONTENTS
1 Nutritional Consequences of Acute Diarrhea .
Introduction
Decrease in Dietary Intake
Decrease in Intestinal Absorption
Increase in Nutrient Requirements
Potential Complications of Continued Feeding
2 Therapy for Diarrhea . . . . . . . .
Oral Rehydration Therapy
Effects of Oral Rehydration Therapy
on Nutritional Status
Nutritional Therapy
Choice of Foods
Food Preparation
Frequency and Progression of Feeding
Monitoring Nutritional Therapy for Diarrhea
Antibiotic and Antidiarrheal Agents
· ~
3. Research Recommendations .
Basic Research
Programmatic Research
4. Summary .
Appendix: Energy Needs for Recovery from the Effects
of Diarrhea
References . .
2
4
7
8
11
11
13
13
15
18
21
23
25
27
27
28
29
1X —
31
35
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