The role of nutrition in diarrhoea syndromes

Diarrhoea is a common and worldwide problem, accounting for significant morbidity and mortality, especially in children. This paper reviews recent advances in the field of nutritional intervention for the prevention and treatment of diarrhoeal diseases.

In the developing countries, the incidence of diarrhoeal diseases remains unchanged, whereas in industrialized areas a decrease has been reported. In acute diarrhoea, oral rehydration therapy is the treatment of first choice. Newer oral rehydration solutions with amylase-resistant starch or partially hydrolysed guar gum have been tested and found to be useful. Promising new data on supplementation with zinc in acute diarrhoea were published last year. The use of prebiotics and probiotics in the prevention and the treatment of diarrhoea is still controversial. However, new data and meta-analyses with probiotics are available, showing benefits in the treatment of acute diarrhoea as a co-treatment with oral rehydration. The same benefits were found to apply to antibiotic-associated diarrhoea syndromes. The co-administration of probiotics to patients receiving antibiotics seems to be a promising approach for reducing the incidence of antibiotic-associated diarrhoea. New evidence suggests that fibre reduces diarrhoea associated with enteral tube feeding. Furthermore, a new probiotic mixture (VSL-3, viable lyophilized bacteria of 4 strains of Lactobacillus, 3 strains of Bifidobacterium and 1 strain of Streptococcus thermophilus (VSL Pharmaceuticals, Inc,. Ft. Lauderdale, FL. USA)) was of benefit in the treatment of bacterial overgrowth and in the prevention of diarrhoea after pelvic radiation treatment.

Oral rehydration is still the first line of treatment for acute diarrhoea. Zinc supplements have been shown to have a beneficial effect on acute diarrhoea in children. Probiotics and fibre have proved to be useful in the prevention and treatment of several diarrhoea syndromes. Because of the small numbers of patients and shortcomings in design and analysis, additional large placebo-controlled trials of the effects of fibre and probiotics, or a combination of both, in diarrhoea syndromes are needed.