Dietary intake and clinical response of hospitalized patients with acute diarrhea

Diarrhea and malnutrition remain major health problems among children of developing countries. During diarrhea, the patient's dietary intake and absorption of nutrients are reduced while nutritional requirements are increased.

To determine the relationship between food intake and clinical response during the hospital stay of patients with acute diarrhea.

A hospital-based longitudinal study was conducted in 118 patients with acute diarrhea aged 6 to 59 months who required treatment for at least 3 days in the in-patient ward in Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B). Daily food intake was measured and anthropometric measurements were taken to assess nutritional status. Daily stool weight and clinical records were collected. The data were analyzed with SPSS/PC+, version 10, and EPI STAT, version 3.2.2.

The duration of diarrhea was 50% greater in patients with lower energy intake (less than 50% of the recommended dietary allowance [RDA]) than in those with higher energy intake (6 vs. 4 days, p = <.001). Patients with lower energy intake had 22% greater stool output than those with higher energy intake (122.65 vs. 100.37 mL/kg body weight/day, p = .04). Among patients with lower energy intake, the weight-for-age and weight-for-height z-scores (WAZ and WHZ) at discharge from the hospital were higher than those at admission (-3.53 +/- 1.25 vs. -3.67 +/- 1.31 and 1.95 +/- 1.23 vs. -2.14 +/- 1.22, respectively; p = .001 for both comparisons), but these scores did not differ at admission and discharge among patients with higher energy intake. The Kaplan-Meier survival function showed that 80% of well-nourished children (WAZ > or = -2), as compared with 58% of malnourished children (WAZ < -2), recovered by the 4th day of treatment (p < .01). The length of the recovery period was related negatively with total energy intake (p = < .001) and mid-upper-arm circumference (p = .004) and positively with stool weight.

Food intake was reduced in the hospitalized children because of severe illness. Patients with lower energy intake as a percentage of RDA had delayed clinical recovery and higher stool output.