Nutritional status, body size and severity of diarrhoea associated with rotavirus or enterotoxigenic Escherichia coli

Abstract

Abstract

Children with severe malnutrition have an increased risk of death from diarrhoea. To determine if the clinical manifestations of specific types of diarrhoea differed according to the nutritional status or size (weight and length) of the patient, we studied children with acute diarrhoea associated with rotavirus or enterotoxigenic Escherichia coli. In this study we found that a child's body size, which was determined by his age and nutritional status, was a significant predictor of his rate of stool output per kilogram of body weight. Thus, children who are small because of young age and/or malnutrition appear to lose a greater proportion of their total fluid volume during diarrhoea and might be expected to have a higher frequency of severe dehydration and death, if untreated.

PIP: This study assessed the effects of undernutrition (measured by weight-for-length) and low body weight on stool output rates in 82 children under 5 years of age with diarrhea associated with rotavirus or enterotoxigenic Escherichia coli. Although weight-for-length status did not affect stool output, children appeared to lose fluid as a greater rate if they had low body weight. Lower-weight children had rates of stool loss 14-61% greater than higher-weight children. Multiple regressionanalysis aimed at determining whether age, weight, or length was the best predictor of stool output found that length was the best predictor. However, weight and age are likely to be indirectly related to diarrheal severity, since malnutrition and young age are reasons for smaller body weight or length. It is hypothesized that the small intestine of an underweight child is greater in proportion to body weight than that of a normal weight child, resulting in larger stool losses per kg/body weight. The finding that children of small body size lose a greater proportion of their body fluid during diarrhea suggests that these children should be regarded as a high risk group during diarrhea. Special attention should be given to water and electrolyte replacement to prevent dehydration and death among these children