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Query: UMLS:C0740441 (acute diarrhea)
 2,275 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Malnutrition increases morbidity and mortality and affects physical growth and development, some of these effects resulting from specific micronutrient deficiencies. While public health efforts must be targeted to improve dietary intakes in children through breast feeding and appropriate complementary feeding, there is a need for additional measures to increase the intake of certain micronutrients. Food-based approaches are regarded as the long-term strategy for improving nutrition, but for certain micronutrients, supplementation, be it to the general population or to high risk groups or as an adjunct to treatment must also be considered. Our understanding of the prevalence and consequences of iron, vitamin A and iodine deficiency in children and pregnant women has advanced considerably while there is still a need to generate more knowledge pertaining to many other micronutrients, including zinc, selenium and many of the B-vitamins. For iron and vitamin A, the challenge is to improve the delivery to target populations. For disease prevention and growth promotion, the need to deliver safe but effective amounts of micronutrients such as zinc to children and women of fertile age can be determined only after data on deficiency prevalence becomes available and the studies on mortality reduction following supplementation are completed. Individual or multiple micronutrients must be used as an adjunct to treatment of common infectious diseases and malnutrition only if the gains are substantial and the safety window sufficiently wide. The available data for zinc are promising with regard to the prevention of diarrhea and pneumonia. It should be emphasized that there must be no displacement of important treatment such as ORS in acute diarrhea by adjunct therapy such as zinc. Credible policy making requires description of not only the clinical effects but also the underlying biological mechanisms. As findings of experimental studies are not always feasible to extrapolate to humans, the biology of deficiency as well as excess of micronutrients in humans must continue to be investigated with vigour.
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PMID:Micronutrient deficiency in children. 1150 11

This report summarizes the current knowledge on the effects of zinc supplementation on the management of acute diarrhoea. All published and unpublished studies on this topic, conducted in hospitals and in the community, were reviewed. Based on the results of this review, it is concluded that there is now enough evidence demonstrating the efficacy of zinc supplementation on the clinical course of diarrhoea, with regard to the severity and duration of the episode. However, the meeting also concluded that effectiveness studies to assess the feasibility, sustainability, and cost-effectiveness of different strategies for delivering zinc supplementation should be undertaken.
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PMID:Effect of zinc supplementation on clinical course of acute diarrhoea. 1185 58

When diarrhoea caused by gastroenteritis persists for more than two weeks it is referred to as persistent diarrhoea in developing countries. Whilst the Control of Diarrhoeal Diseases programme has decreased mortality from acute diarrhoea, mortality from persistent diarrhoea has not been so responsive. A number of factors have been identified which are determinants for the progression of an acute episode to one which persists in developing communities. In one study from west Africa, current infection with Cryptosporidium parvum was the most significant factor. In studies from Brazil and India, continuing infection with enteropathogenic Escherichia coli was identified in 50% of infants with persistent diarrhoea. Persistent small intestinal mucosal damage is of key importance in such children. Management of established cases is complex and difficult. However, there is clear evidence that zinc is involved in the recovery of small intestinal mucosa after injury. Zinc supplementation may indeed significantly reduce the duration of persistent diarrhoea. However, the whole question of public health supplementation with zinc, vitamin A, or other supplements, is contentious at present.
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PMID:Post-infective diarrhoea. 1196 77

From 1987-1989, researchers conducted a double blind randomized controlled clinical trial among 301 infants 3-24 months old with acute or persistent diarrhea in Bangladesh to determine the impact of 2 weeks of zinc acetate (15mg/kg/day) supplementation on intestinal function, morbidity, and growth. A significant increase in mean serum levels of zinc occurred in infants with acute diarrhea, but levels did not change in those with persistent diarrhea. Zinc supplementation substantially improved the intestine's mucosal permeability after 1 week in infants with persistent diarrhea and after 2 weeks in those with acute diarrhea. Moreover, infants with acute diarrhea who received zinc experienced significant weight gain during hospitalization. In addition, the weight of those with persistent diarrhea who received zinc did not falter. All children with acute diarrhea who received zinc grew taller than the placebo group (18.9mm vs. 14.5mm; p.03). Among persistent diarrhea children, zinc supplementation resulted in a significant 22% decrease in the number of lighter children (70% weight/age) and a significant 30% decrease in wasted children (78% height/age) during hospitalization. These same children experienced significantly higher linear growth and height gain after leaving the hospital. Further, zinc supplemented infants with persistent diarrhea had a significantly lower diarrhea attack rate and lower duration of diarrhea than those in the placebo group. Similarly, zinc supplementation in the lighter children with acute diarrhea substantially decreased mean diarrhea attack rate (.4 vs .1) and duration (.8 vs. 3 days). In addition, it also significantly reduced attacks and duration of both diarrhea and respiratory tract infections in shorter children (90% height/age). Physiological and nutritional studies are needed to learn the mechanisms involved.
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PMID:Effect of zinc supplementation in patients with acute and persistent diarrhoea. 1228 14

Mortality from diarrheal diseases is most common in areas with high prevalence of caloric malnutrition. The considerable reduction of mortality from diarrhea following introduction of oral rehydration therapy has revealed the seriousness of persistent diarrhea with malnutrition. Persistent diarrhea is internationally defined as a diarrheal episode lasting 14 days or longer, generally accompanied by growth problems and protein calorie malnutrition. Persistent diarrhea is now considered a nutritional disease, generally occurring in low birth weight or malnourished children and itself a significant cause of protein calorie malnutrition. 10% of episodes of acute diarrhea are believed to evolve into persistent diarrhea, which accounts for 35% of deaths from diarrhea. Around 15% of episodes of persistent diarrhea are fatal. Several risk factors have been identified. Most patients are under one year old. Various studies have shown that protein calorie malnutrition retards repair of the damaged intestinal epithelium and prolongs diarrhea. Recent introduction of milk of animal origin is implicated in 30-40% of episodes of persistent diarrhea. Patients at risk have been shown to react abnormally to skin tests of antigens and to have recent histories of acute diarrhea or previous episodes of persistent diarrhea. Inconclusive studies implicate antimotilic drugs such as paregoric elixir and indiscriminate use of antibiotics as risk factors, but increased risk has been proven only with some antiparasitics. Patients with persistent diarrhea are deficient in vitamins A, B12, and folic acid, and in zinc and iron. Children under 6 months of age with persistent diarrhea should be hospitalized. Adequate feeding is the most important aspect of treatment. The objectives of nutritional treatment include temporary reduction of milk of animal origin, assurance of sufficient protein and calorie consumption, avoidance of foods aggravating the diarrhea, and correction of existing malnutrition.
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PMID:[Persistent diarrhea]. 1229 May 53

Acute diarrhea is still responsible for about 40% of diarrhea-associated deaths, and oral rehydration therapy (ORT) does not actually reduce the duration of diarrhea. A species of lactobacilli specific for the human gut was first isolated in 1987, Lactobacillus casei strain GG, and several trials have used colonization of the gut by this organism as an adjunct to ORT. A placebo-controlled, triple-blind study in Pakistan showed a significant reduction in the number of children with persistent watery stools at 48 hours, as well as a reduction in stool output and vomiting. Dioctahedral smectite (DS) has been found to adsorb viruses, bacteria, and toxins resulting in the protection of gut mucosa. A randomized double-blind trial (placebo-controlled) studied outcome in 90 males, 3-24 months old, with acute diarrhea of or= 5 days duration. After rehydration, patients were given either 1.5 g of DS or placebo 4 times a day for 3 days. At 48 hours, 42% of the treatment group were free from diarrhea, as opposed to 13% of the placebo group, and at 3.5 days 20% of the placebo group still had diarrhea, as opposed to none in the treatment group. Mean duration of diarrhea in the treatment groups was 54.1 hours (placebo 72.9 hours, p 0.001). However, mean stool output was similar (97.9 g/kg vs. 110.9 g/kg). Bismuth subsalicylate (BSS) has been frequently used in adults with benefits in both prevention and treatment. 142 Chilean children 4-36 months old were randomized to receive either placebo or BSS (100 mg/kg/day) 5 times a day for 5 days. Stools were normal in the E. coli group by 72 hours as opposed 139 hours in the placebo group (p 0.01), while rotavirus-infected stools normalized in 57.5 hours, as opposed to 104.5 hours in the placebo group. Other effective approaches include micronutrient supplementation including zinc and folate.
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PMID:Paediatrics Forum. Acute diarrhoea. 1231 47

Zinc has been recognized as an antioxidant with potential for chronic and acute effects. Oxidative damage produced by free radicals, including nitric oxide (NO), is responsible for certain types of intestinal malabsorption syndromes and diarrhea. Under physiologic or mildly stimulatory conditions for NO synthesis, the small intestine characteristically is in a proabsorptive state; however, an excessive production of NO triggers formation of cyclic nucleotides, which cause secretion and malabsorption. In this study, we hypothesized that low-molecular-weight, soluble zinc chelates could modulate the effects of induced NO excess on the small intestine. In vitro experiments demonstrated that zinc-citrate or zinc-histidine at > or =0.66 mM, as well as a known NO scavenger, 2-[carboxyphenyl]-4,4,4,4-tetramethylimidazoline-1-oxyl-3-oxide, at 2 microM, were effective at removing chemically generated NO. In vivo jejunal perfusions, conducted in healthy rats under anesthesia, showed that c-PTIO reduced the proabsorptive effects produced by 1 mM L-arginine, the precursor of NO. In a standard oral rehydration solution, 1 mM zinc-citrate partially reversed the antiabsorptive effects on potassium caused by an excess of NO generated from 20 mM L-arginine but did not alter sodium or water absorption. The data are consistent with the view that soluble zinc compounds incorporated into an oral rehydration solution may deserve further attention as a means to scavenge NO with fluids used for the treatment of chronic or acute diarrhea, especially in malnourished children who are often zinc deficient.
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PMID:Zinc as a potential enteroprotector in oral rehydration solutions: its role in nitric oxide metabolism. 1259 91

Diarrheal diseases remain an important cause of childhood morbidity and death in developing countries, although diarrheal deaths have significantly declined in recent years, mostly due to successes in the implementation of oral rehydration therapy (ORT), which is the principal treatment modality. Diarrhea may occur for varied reasons; however, most episodes of diarrhea in developing countries are infectious in origin. Three clinical forms of diarrhea (acute watery diarrhea, invasive diarrhea, and persistent diarrhea) have been identified to formulate a management plan. Acute diarrhea may be watery (where features of dehydration are prominent) or dysenteric (where stools contain blood and mucus). Rehydration therapy is the key to management of acute watery diarrhea, whereas antimicrobial agents play a vital role in the management of acute invasive diarrhea, particularly shigellosis and amebiasis. In persistent diarrhea, nutritional therapy, including dietary manipulations, is a very important aspect in its management, in addition to rehydration therapy. Rehydration may be carried out either by the oral or intravenous route, depending upon the degree of dehydration. Oral rehydration salts (ORS) solution (World Health Organization formula) is recommended for ORT. Intravenous fluid is recommended for initial management of severe dehydration due to diarrhea, followed by ORT with ORS solution for correction of ongoing fluid losses. Antimicrobial therapy is beneficial for cholera and shigellosis. Antiparasitic agents are indicated only if amebiasis and giardiasis are present. Appropriate feeding during diarrhea is recommended for nutritional recovery and to prevent bodyweight loss. Antidiarrheal agents do not provide additional benefit in the management of infectious diarrhea. Although some probiotics have been shown to be beneficial in the treatment of acute diarrhea due to rotavirus, their use in the treatment of diarrhea is yet to be recommended, even in developed countries. The children of developing countries might benefit from zinc supplementation during the diarrheal illness, but its mode of delivery and cost effectiveness are yet to be decided.
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PMID:Treatment of infectious diarrhea in children. 1260 80

Although oral rehydration therapy greatly reduces mortality from diarrhoeal diseases, it has little effect on stool frequency. However, there is mounting evidence that zinc is an effective adjunct to the treatment of diarrhoea, although few studies have examined its efficacy in Latin America. This study assessed the efficacy of zinc supplementation in children with acute diarrhoea in Brazil. The study was a double-blind, placebo-controlled, randomised, clinical trial in children <5 years of age attending emergency services in Sergipe, Brazil. Subjects received zinc or vitamin C as placebo. There was a marked reduction in the duration of the diarrhoea (1.1 vs 2.6 days) and of watery stools in the zinc-supplemented group. The efficacy of zinc was independent of the presence of viral enteropathogens in the stools. It is concluded that, similar to studies in India and Bangladesh, zinc could be an important adjunct for treating acute diarrhoea in Brazilian children.
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PMID:Zinc supplementation in Brazilian children with acute diarrhoea. 1264 18

Zinc deficiency places children in many low-income countries at increased risk of illness and death from infectious diseases. Randomized controlled trials of zinc supplementation provide the best estimate of this risk through demonstrated preventive benefits. In six of nine trials that evaluated prevention of diarrhea, significantly lower incidence of diarrhea occurred in the zinc group than in the controls; a pooled analysis demonstrated 18% (95% confidence interval, 7-28%) less diarrhea. In five trials, a lower rate of pneumonia infection was found in the zinc-supplemented groups, and there was some indication of a preventive effect in three trials with a clinical malaria outcome. Zinc was also found to have a therapeutic benefit in seven trials of acute diarrhea and five of persistent diarrhea. Studies to evaluate the effect of zinc supplementation on mortality are under way, but a recently published study from India identified a 68% reduction in mortality in small-for-gestational-age term infants that were supplemented with zinc from 1 to 9 mo of age. The important effects of zinc deficiency are now clear, and nutrition programs should address this prevalent problem.
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PMID:Zinc deficiency, infectious disease and mortality in the developing world. 1273 Apr 49


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