DIETARY SUPPLEMENTATION AND RAPID CATCH-UP GROWTH AFTER ACUTE DIARRHEA IN CHILDHOOD

Diarrhoea is a major cause of short-term growth faltering in children of the developing world. If catch-up weight gain is delayed by inadequ ate dietary intake, or by further bouts of diarrhoea, progressive grow th failure occurs. To test the hypothesis that early refeeding is as e ffective as later feeding after acute diarrhoea with weight loss, we m easured the effects of a timed dietary intervention on weight gain aft er acute diarrhoea in underweight Gambian children, Thirty-four childr en aged 4-22 months with weight loss following acute diarrhoea were gi ven a high-energy-protein supplement for 14 d beginning either immedia tely after rehydration or a fortnight later, With a 50 % increase in e nergy intake and a 100 % increase in protein intake there was a rapid and highly significant (P < 0.001) gain in weight within a fortnight w hether the supplement was given immediately or 2 weeks after presentat ion, Rates of weight increase were similar whether supplementation was provided early or late, but over the full 28 d (of intervention and n on-intervention) children who received late supplementation had greate r overall weight gain (P < 0.02) than those supplemented early, Vigoro us and early feeding with a high-energy-protein supplement should be c entral to the management of malnourished children with acute diarrhoea in developing countries, and may be as important as control of diarrh oea in preventing malnutrition and growth failure, This may be achieve d in the community using locally available foods, in the face of conti nuing diarrhoea.