Absorption of macronutrients from a calorie-dense diet in malnourished children during acute shigellosis

Abstract

A metabolic balance study was performed to determine the absorption of macronutrients and energy from different food items in 23 malnourished children aged 12 to 48 months with clinically severe acute dysentery due to shigellosis. In a 72-h balance period, the absorption of carbohydrate, protein, fat, and total energy was determined. All the children received a standard hospital diet; 12 children in the test group were offered an additional calorie-dense milk (5.0 kJ/ml with a protein-energy ratio of 11.0), and 11 children in the control group, on the other hand, received a milk formula with an energy of 2.5 kJ/ml with a protein-energy ratio of 11.0. The intakes (g/kg/day) of protein, fat, carbohydrate, and energy between test and control groups were 4.25 versus 2.32 (p = 0.01), 7.63 versus 3.00 (p = 0.01), 21.09 versus 11.14 (p = 0.01), and 711 kJ/kg/day versus 338 kJ/kg/day (p = 0.01), respectively. The coefficients of absorption of protein, fat, carbohydrate, and energy between test and control groups were 61 versus 67% (p = 0.45), 69 versus 82% (p = 0.11), 77 versus 86% (p = 0.13), and 72 versus 82% (p = 0.13), respectively. The losses (g/kg/day) of protein, fat, carbohydrate, and energy between the two groups were 1.61 versus 0.76 (p = 0.00), 2.44 versus 0.55 (p = 0.00), 5.0 versus 1.6 (p = 0.00), and 204 kJ/kg/day versus 60 kJ/kg/day, respectively. The results of this study indicate that during the acute stage of shigellosis (with a substantially enhanced total intake of protein, fat, carbohydrate, and energy), by adding calorie-dense meals in malnourished children younger than 5 years, the absorption of macronutrients is not significantly different from that with the usual diet but suboptimal dietary energy intake, as is the case under ordinary treatment conditions