Diarrhoea is a major cause of short-term growth faltering in children of the developing world. If catch-up weight gain is delayed by inadequate dietary intake, or by further bouts of diarrhoea, progressive growth failure occurs. To test the hypothesis that early refeeding is as effective as later feeding after acute diarrhoea with weight loss, we measured the effects of a timed dietary intervention on weight gain after acute diarrhoea in underweight Gambian children. Thirty-four children aged 4-22 months with weight loss following acute diarrhoea were given a high-energy-protein supplement for 14 d beginning either immediately after rehydration or a fortnight later. With a 50% increase in energy intake and a 100% increase in protein intake there was a rapid and highly significant (P < 0.001) gain in weight within a fortnight whether the supplement was given immediately or 2 weeks after presentation. Rates of weight increase were similar whether supplementation was provided early or late, but over the full 28 d (of intervention and non-intervention) children who received late supplementation had greater overall weight gain (P < 0.02) than those supplemented early. Vigorous and early feeding with a high-energy-protein supplement should be central to the management of malnourished children with acute diarrhoea in developing countries, and may be as important as control of diarrhoea in preventing malnutrition and growth failure. This may be achieved in the community using locally available foods, in the face of continuing diarrhoea.
PIP: During June 1990-February 1991 in Keneba village, the Gambia, the Medical Research Council (MRC) Dunn Nutrition Unit clinic randomly assigned 40 children 4- 22 months old with diarrhea to either an early nutritional intervention group or a late nutritional intervention group to test whether early feeding is as effective as later feeding after acute diarrhea with weight loss. 34 children completed the study. All the children received oral rehydration solution within 24 hours after entering the study. The nutrition intervention was a short-term, high energy-protein supplement (50% increase in energy intake, 100% in protein intake, and 30% increase in the proportion of energy supplied by protein). Immediately after rehydration, the early intervention children were given this supplement daily for 2 weeks, after which they returned to their home diet. The later intervention children first received their home diet then received the supplement daily during days 15-28. Regardless of nutritional interventions given, the children gained weight rapidly and significantly within 2 weeks (p 0.001). Early feeding resulted in achievement of baseline weight 3.5 times faster than late feeding (around day 5 vs day 14; p 0.001). Yet, over the full 28 days of follow-up (intervention and non-intervention), the late intervention group gained more weight overall than the early intervention group (mean change in weight-for-age Z-score, 0.62 vs. 0.22; p 0.02). These findings suggest that late nutrition supplementation leads to greater overall weight gain after acute diarrhea in childhood than early supplementation, but early nutrition supplementation leads to a faster return to baseline weight than late supplementation. Thus, in populations with a high prevalence of diarrhea and undernutrition, short-term nutritional supplementation with a high energy-protein supplement is needed to promote rapid catch-up growth and nutritional recovery. The supplement can be made of locally available, locally prepared foods and can be administered outside of a hospital.