Diarrhoea Complicating Severe Acute Malnutrition in Kenyan Children: A Prospective Descriptive Study of Risk Factors and Outcome A semi-elemental diet with low osmolarity and high content of hydrolyzed lactalbumin in the treatment of acute diarrhea in malnourished children. Milk formulas in acute gastroenteritis and malnutrition: a randomized trial.
Background Severe acute malnutrition ( SAM ) accounts for two million deaths worldwide annually . In those hospitalised with SAM , concomitant infections and diarrhoea are frequent complications result ing in adverse outcome . We examined the clinical and laboratory features on admission and outcome of children with SAM and diarrhoea at a Kenyan district hospital . Methods A 4-year prospect i ve descriptive study involving 1,206 children aged 6 months to 12 years , hospitalized with SAM and managed in accordance with WHO guidelines .  Data on clinical features , haematological , biochemical and microbiological findings for children with diarrhoea ( ≥3 watery stools/day ) were systematic ally collected and analyzed to identify risk factors associated with poor outcome . Results At admission 592 children ( 49 % ) had diarrhoea of which 122 ( 21 % ) died compared to 72/614 ( 12 % ) deaths in those without diarrhoea at admission ( Χ2 = 17.6 p<0.001 ) . A further 187 ( 16 % ) children developed diarrhoea after 48 hours of admission and 33 died ( 18 % ) . Any diarrhoea during admission result ed in a significantly higher mortality 161/852 ( 19 % ) than those uncomplicated by diarrhoea 33/351 ( 9 % ) ( Χ2 = 16.6 p<0.001 ) . Features associated with a fatal outcome in children presenting with diarrhoea included bacteraemia , hyponatraemia , low mid-upper arm circumference < 10 cm , hypoxia , hypokalaemia and oedema . Bacteraemia had the highest risk of death ( adjusted OR 6.1 ; 95 % C.I 2.3 , 16.3 p<0.001 ) ; and complicated 24 ( 20 % ) of fatalities . Positive HIV antibody status was more frequent in cases with diarrhoea at admission ( 23 % ) than those without ( 15 % , Χ2 = 12.0 p = 0.001 ) but did not increase the risk of death in diarrhoea cases . Conclusion Children with SAM complicated by diarrhoea had a higher risk of death than those who did not have diarrhoea during their hospital stay . Further operational and clinical research is needed to reduce mortality in children with SAM in the given setting Thirty-eight moderately to severely malnourished children with severe acute or subacute diarrhea were treated according to two different feeding schemes , divided at r and om half of the children received semi-elemental diet ( SED ) with an osmolarity of 302 milliosmol per liter , a low lactose content and a relatively high content of lactalbumine hydrolysate ( 1 g/100 ml ) . The other half of the patients received available proprietory formulas or diluted cow 's milk with added carbohydrates . The results obtained showed that the children who were fed the SED had a better average weight gain during the first three weeks of hospitalization compared to the control group . The children receiving the SED also required a smaller number or rehydrations OBJECTIVE To compare three low-lactose milk formulas differing in osmolality and degree of protein hydrolysis in the treatment of diarrhoea and malnutrition in subjects with high rates of lactose intolerance , osmotic diarrhoea and a tropical/environmental enteropathy . METHODS A r and omized double-blind trial of 180 Aboriginal children under 3 years of age admitted with acute diarrhoea and /or malnutrition was carried out . The intervention milk formulas were : ( i ) De-Lact , a low-osmolality lactose-free formula ; ( ii ) O-Lac , a lactose-free formula ; and ( iii ) Alfaré , a partially hydrolysed formula . Outcome measures were diarrhoeal severity , weight gain , formula palatability and changes in intestinal permeability ( L/R ratios ) . RESULTS The duration of diarrhoea in days ( mean ; 95 % confidence interval ) was significantly longer on Alfaré ( 8.5 ; 7.0 - 10.0 ) compared to De-Lact ( 6.1 ; 5.0 - 7.2 ) and O-Lac ( 6.9 ; 5.6 - 8.1 ; P = 0.04 ) . There were no differences in mean intake between formulas , but palatability of Alfaré was significantly worse ( P < 0.01 ) than the other formulas . Over the trial 5 days , improvement in L/R ratios was significantly greater ( P = 0.05 ) for De-Lact ( 18.6 ; 10.6 - 26.6 ) than for Alfaré ( 8.5 ; 2.1 - 14.9 ) . Weight gain was not significantly different between the three formulas , except in a malnourished subgroup who had better weight gain on De-Lact ( P = 0.05 ) . CONCLUSIONS In these Aboriginal children with diarrhoea and growth failure , a low osmolality milk was associated with better outcomes and a partially hydrolysed formula with less improvement in mucosal recovery , suggesting that cow 's milk protein intolerance is not contributing to greater diarrhoeal severity or enteropathy in Aboriginal children
CONTEXT Severe acute malnutrition ( SAM ) accounts for approximately 1 million child deaths per year .
High mortality is linked with comorbidities , such as diarrhea and pneumonia .
OBJECTIVE The aim of this systematic review was to determine the extent to which carbohydrate malabsorption occurs in children with SAM .