Nutritional Therapy of Chronic Diarrhea

Before one considers active nutritional therapy for a global problem as devastating and massive as chronic infant diarrhea, one should consider the preventive aspects of nutritional care. The favorable impact of breast-feeding on the incidence and course of diarrheal disease has been rediscovered and reaffirmed in most parts of the world. This very important protection provided by breastfeeding, particularly during the first very vulnerable year of life, must not be minimized. A second somewhat related preventive nutritional point concerns food as an actual source of initial, recurrent, or persistent intestinal infestation and infection in some regions of the world. We all recognize that if all babies could be breast fed and if all of their drinking water and other foods could be cleared of contamination, the incidence and severity of both acute and chronic diarrhea could be greatly reduced. The World Health Organization, through its Diarrheal Disease Control Programme, is addressing these issues. In providing nutrients to a child at the time of a severe chronic diarrheal illness, the theoretical options are many. Foods can be given as solids or liquids, as natural, hydrolyzed, or synthetic (elemental) products, either continuously or intermittently, by the digestive tract, orally or by tube into the stomach, small intestine, or even the colon, or by peripheral or central vein. Although many questions remain, considerable advances have been made in developing concepts of the causes and mechanisms of chronic diarrhea and the accurate clinical evaluation of specific patients. At the same time, improvements have been made in products and delivery systems for active nutritional care. This volume attests to the fact that these two developments are still a long way from answering the needs of the baby with chronic diarrhea. This chapter examines some current theoretical considerations for the nutritional management of these babies. In doing so, it is essential to recognize, humbling as it may be, that we have insufficient data on which to base the formulation of sweeping feeding policies. In fact, the economic implications of special dietary care are such that inappropriate policies could be extremely counterproductive.