Malnutrition diarrhoea

The morbidity and mortality that are often associated with human GI helminth infections reflect in part the nutritional consequences of diarrhoea and malabsorption, and the resulting malnutrition that can accentuate the effects of infection by suppressing the protective immune response as well as compromising intestinal repair (Ferguson et al., 1980 Keymer and Tarlton, 1991 Cooper et al, 1992). In experimental rodents the pathology associated with infection is characterized by villus atrophy, crypt hyperplasia, goblet cell hyperplasia and infiltration of the mucosa by a variety of... 

Pantothenate deficiency is rare, occurring only in cases of severe malnutrition characteristic symptoms include vomiting, intestinal distress, insomnia, fatigue and occasional diarrhoea. Pantothenate is widespread in foods meat, fish, poulty, whole-grain cereals and legumes are particularly good sources. Although no RDA or RNI value has been established for panthothenate, safe and adequate intake of this vitamin for adults is estimated to be 3-7 mg day-1. Pantothenate is non-toxic at doses up to 10 g day-1. 

C. parvum infections are often asymptomatic, but symptoms such as profuse watery diarrhoea, stomach cramps, nausea, vomiting and fever are typical. The symptoms can last from several days to a few weeks in immunocompetent individuals, but in immunocompromised patients infection can become chronic, lasting months or even years. The mean infective dose for immunocompetent people is dependent on the strain of C. parvum but it is considered to be approximately 100 cells, and infants are more vulnerable to infection. Diarrhoea is a major cause of childhood mortality and morbidity as well as malnutrition in developing countries. Cryptosporidium is the third most common cause of infective diarrhoea in children in such countries, and consequently it plays a role in the incidence of childhood malnutrition. 

A more serious effect of protein—energy malnutrition is impairment of cell proliferation in the intestinal mucosa (section 4.1). The villi are shorter than usual, and in severe cases the intestinal mucosa is almost flat. This results in a considerable reduction in the surface area of the intestinal mucosa, and hence a reduction in the absorption of such nutrients as are available from the diet. As a result, diarrhoea is a common feature of protein—energy malnutrition. Thus, not only does the undernourished person have an inadequate intake of food, but the absorption of what is available is impaired, so making the problem worse. 

A variety of infectious diseases can cause malabsorption and diarrhoea. In many cases, this lasts only a few days and so has no long-term consequences. However, a number of intestinal parasites can cause long-lasting diarrhoea and damage to the intestinal mucosa, leading to malnutrition if the infection remains untreated for too long. 

A number of other intolerances or allergic reactions to foods can also lead to similar persistent diarrhoea, loss of intestinal mucosa and hence malnutrition. The problem of disaccharide intolerance was discussed in section 4.2.2.2. In general, once the offending food has been identified, the patient s condition has stabilized and body weight has been restored, continuing treatment is relatively easy, although avoidance of some common foods may provide significant problems. 

In the third world, poverty is another major factor, often resulting in over-dilution of feeds and unhygienic preparation. There is a great risk of endemic disease due to a lack of clean water and hygiene, inadequate health schemes, poor nutrition and ignorance, which act together to perpetuate the vicious circle of disease and death . Malnutrition and diarrhoea due to bottle feeding with inadequate and inappropriate solids are common. In some countries 40% of the population live below the bread line , in which case artificial feeds for an infant may cost between a quarter and a third of the prescribed... 

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