Diarrhoea and malnutrition
The relationship between diarrhoea and malnutrition is bidirectional: diarrhoea leads to malnutrition while malnutrition aggravates the course of diarrhoea. Many factors contribute to the detrimental effect of diarrhoea on nutrition. Reduced intake (due to anorexia, vomiting, and withholding of feeds), maldigestion, malabsorption, increased nutrient losses, and the effects of the inflammatory response are some of the factors involved. High volume stool losses (greater than 30 ml/kg/day) are associated with a negative balance for protein, fat, and sugar absorption. Enteric infections often cause increased loss of endogenous proteins, particularly after invasive bacterial infections. Initially, the major emphasis of treatment of acute diarrhoea in children is the prevention and treatment of dehydration, electrolyte abnormalities and comorbid conditions. The objectives of diarrhoeal disease management are to prevent weight loss, to encourage catch-up growth during recovery, to shorten the duration and to decrease the impact of the diarrhoea on the child's health. Addressing only diarrhoea or only food security is unlikely to be successful in decreasing the prevalence of malnutrition. Existing evidence provides some guidelines as to the optimal nutritional management of children with diarrhoea and novel treatments may prove to be valuable in future.