Effect of an energy-dense diet on the clinical course of acute shigellosisin undernourished children

To date there have been few reports on the impact of dietary intervention o n the clinical course of acute shigellosis. Current management of acute shi gellosis is primarily focused on antibiotic therapy with less emphasis on n utritional management. In a randomised clinical trial, we examined the role of an energy-dense diet on the clinical outcome in malnourished children w ith acute dysentery due to shigellosis. Seventy-five children aged 12-48 mo nths with acute dysentery randomly received either a milk-cereal formula wi th an energy density of 4960 kJ/l (test group) or a milk-cereal formula wit h energy of 2480 kJ/l (control group) for 10 d in hospital. In both milk-ce real formulas, protein provided 11 % energy. In addition, the standard hosp ital diet was offered to all children and all children received an appropri ate antibiotic for 5 d. The mean food intakes (g/kg per d) in the test and control groups were: 112 (se 2.28) and 116 (se 3.48) (P=0.16) on day 1; 118 (se 2.72) and 107 (se 3.13) (P=0.04) on day 5; 120 (se 2.25) and 100 (se 3 .83) (P=0.04) on day 10. The mean energy intakes (kJ/kg per d) in the test and control groups respectively were: 622 (se 13.2) and 315 (se 11.3) (P<0. 05) on day 1; 655 (se 15.1) and 311 (se 7.98) (P<0.05) on day 5; 672 (se 14 .7) and 294 (se 11.1) (P<0.05) on day 10. The food and energy intakes were mostly from the milk-cereal diet. There was no difference between two group s in resolution of fever, dysenteric (bloody and or mucoid) stools, stool f requency and tenesmus. However, vomiting was more frequently observed among the test-group children during the first 5 d of intervention (67 % v. 41 % , P=0.04). There was an increase in the mean weight-for-age (%) in the test group compared with the control group after the 10 d of dietary interventi on (6.2 (se 0.6) v. 2.7 (se 0.4), P<0.01). In addition, resolution of recta l prolapse was better (26 % v. 8 %, P=0.04) in the test group v. control gr oup after 5 d, and 13 % v. 6 %, (P=0.08) after 10 d of dietary intervention . Supplementation with a high-energy diet does not have any adverse effect on clinical course of acute shigellosis and reduces the incidence of rectal prolapse in malnourished children.