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Journal of the American College of Nutrition, Vol. 18, No. 4, 303-308 (1999)
Published by the American College of Nutrition

Original Paper

Acute Diarrhea and Malnutrition: Lethality Risk in Hospitalized Infants

Ulysses Fagundes-Neto, MD, PhD and Jacy A.B.de Andrade, MD, PhD

Department of Pediatric Gastroenterology, Umberto I Hospital, São Paulo Federal University/Escola Paulista de Medicina, São Paulo, BRAZIL

Address reprint requests to: Ulysses Fagundes Neto, M.D., Ph.D., Av. Cons. Rodrigues Alves 1239, São Paulo, SP, BRAZIL

Objectives: Acute diarrhea is a very frequent disease in developing countries and is the first cause of death in infants under two years of age. This study was designed to evaluate the clinical and epidemiological factors associated to the death of 17 out of 511 infants hospitalized due to severe acute diarrhea between January 1989 and December 1995.

Patients and Methods: The patients were divided into two groups according to their clinical evolution: Group I—Death and Group II—Survival. The following parameters were evaluated: birth weight, gender, age, duration of diarrhea (days) prior to admission, nutritional status, hydration, presence of an enteropathogenic agent in the stools, food intolerance and duration of hospitalization.

Results: The analyzed factors have shown a significant association with death for the following variables: age, relative factor of death (RFD)=4.0 for infants less than six months of age, identification of an enteropathogenic Escherichia coli (EPEC) strain in the stools (RFD=3.3), severe malnutrition at admission to the hospital (RFD=4.5), occurrence of food intolerance during hospitalization (RFD=2.7). Some enteropathogenic agent was identified in the stools of 253 infants (54.9%), among the 461 (90.2%) studied. Group I revealed the presence of an enteropathogenic agent in 75% of the cases. The most frequent agents identified in Group I were: EPEC (56.3%) and Shigella (12.5%), while in Group II EPEC was identified in 26.5% of the patients.

Conclusions: The association of some factors, such as age less than six months, severe malnutrition, food intolerance and the identification of EPEC strains in the stool culture, indicate a high risk of death in infants hospitalized due to severe acute diarrhea.

Key words: acute diarrhea, lethality, malnutrition, enteropathogenic Escherichia coli

Abbreviations: NCHS=National Center of Health Statistics • WHO=World Health Organization • PCM=protein calorie malnutrition • RFD=risk factor of death • A/E=attaching and effacing • EPEC=enteropathogenic Escherichia coli • EIEC=enteroinvasive Escherichia coli • ETEC=enterotoxigenic Escherichia coli • EHEC=enterohemorrhagic Escherichia coli






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Copyright © 1999 by the American College of Nutrition.