Thermophilic Amylase-Digested Rice-Electrolyte Solution in the Treatment of Acute Diarrhea in Children

Objective. To compare the efficacy of an oral rehydration solution (ORS) containing short polymers of glucose derived from rice (Amylyte-ORS) and five times the caloric density of current ORS to the standard glucose-ORS (World Health Organization [WHO] = ORS) in the treatment of acute diarrhea in children. Methods. The rice ORS (Amylyte-ORS) was obtained by adding thermophilic amylase (252 500 MW units) and salts (1.5 g NaCl, 600 mg KCl, and 150 mg CaCl2) to 100 g rice and boiling for 10 minutes in 500 mL water. This yields 250 mL Amylyte-ORS, which contains 92% to 96% short-chain glucose polymers, three to nine molecules in length, and provides 425 kcal/L, compared to 80 kcal/L for the WHO-ORS. One hundred forty-four male children, 4 months to 3 years of age, presenting with acute diarrhea and mild, moderate, or severe dehydration, were assigned by random allocation to receive either WHO-ORS or Amylyte-ORS. Data from 127 children were analyzed (57 received the WHO-ORS and 70 the Amylyte-ORS). Two children given Amylyte-ORS and 15 given the WHO-ORS were not included in the analysis because of improperly collected data or lost urine or fecal specimens. None were given antibiotics during the study. Free water and feeding were allowed after the children were rehydrated. Results. The clinical characteristics of the children in the two treatment groups were comparable. Five children who received the WHO-ORS and three children given Amylyte-ORS were treatment failures. Amylyte-ORS reduced diarrhea duration by 15% (41.4 ± 2.5 vs 34.7 ± 1.8 hours; P < .03) compared to the WHO-ORS, regardless of the severity of dehydration. In the Amylyte-treated group, ORS requirements were significantly less (234 ± 15.2 vs 295 ± 17.6 mL/kg P < .01) and weight gain was significantly more (367.7 ± 45.1 vs 199.2 ± 38.2 g; P < .01) than in those given the WHO-ORS. The net intestinal fluid balance and total body fluid balance were similar in the two groups. Conclusions. Amylyte-ORS efffectively rehydrates children with acute diarrhea, reduces diarrhea duration, decreases ORS requirements, and improves weight gain compared to the WHO-ORS.

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Letter to the Editor

PEDIATRICS ◽

10.1542/peds.94.6.963b ◽

1994 ◽

Vol 94 (6) ◽

pp. 963-964

Author(s):

Virginia L. Richmond

Keyword(s):

Nutritional Status ◽

World Health Organization ◽

Oral Rehydration Solution ◽

World Health ◽

Whole Body ◽

Childhood Diarrhea ◽

Oral Rehydration ◽

The World ◽

Rehydration Solution ◽

Health Organization

The article by Jacobs et al1 regarding treatment of acute childhood diarrhea with homeopathic medicine as an adjunct to the World Health Organization Oral Rehydration Solution (ORS) omits some essential measurements needed for comparison with previous literature reports and pertinent references from the last 15 years. The authors ignored the whole body of literature on rice- or cereal-based ORS (CB-ORS) that dealt with much larger patient samples and more precise measurements.2 These reports empha-sized the variability of results depending on the previous nutritional status of the child and whether adequate, nutritious diets were actually given the child on early refeeding.3

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Technical Report Abstract: The Management of Acute Gastroenteritis in Children—Technical Report for the American Academy of Pediatrics Practice Parameter

PEDIATRICS ◽

10.1542/peds.97.3.436 ◽

1996 ◽

Vol 97 (3) ◽

pp. 436-436

Author(s):

GAIL R. BROWN ◽

PETER MARGOLIS

Keyword(s):

Acute Gastroenteritis ◽

Developed Countries ◽

World Health ◽

Practice Parameter ◽

Oral Rehydration ◽

Technical Report ◽

Control And Prevention ◽

Quantitative Synthesis ◽

Evidence Model ◽

Health Organization

This technical report describes the process followed in the development of the AAP practice parameter on acute gastroenteritis, as well as the evidence used to formulate the final recommendations. An evidence model that defined acute gastroenteritis and identified diagnostic tests and interventions used in its management and outcomes of importance was used to identify topics to include in the guideline. The three topics selected were: (1) methods of rehydration, (2) refeeding after rehydration, and (3) the use of antidiarrheal agents. Primary outcomes of interest were duration of disease, complications of therapy, parental satisfaction, and cost. Multiple bibliographic sources were searched to identify articles related to these areas; the sources included MEDLINE, reports on gastroenteritis from the Centers for Disease Control and Prevention and the World Health Organization, the Federal Register, a report to the Food and Drug Administration, and files of the expert panel. More than 4000 articles were initially reviewed, of which 230 were identified as being potentially related to the three topics. Qualitative aspects of the literature reviewed were summarized in evidence tables. Sufficient data for quantitative summary were available only for refeeding after rehydration. In this analysis, the weighted difference across studies between treatment and control groups in the mean duration of diarrhea was used as the measure of the relative benefit of one form of therapy over another. Methods of Rehydration Evidence comparing oral rehydration and intravenous therapy was limited to five reports of randomized trials conducted in developed countries. It was not possible to perform a quantitative synthesis of this information because of a lack of similar outcomes.

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Development of Hypotonic Electrolyte Rehydration Drinks from Paneer and Cheese Whey

The Indian Journal of Nutrition and Dietetics ◽

10.21048/ijnd.2019.56.1.20813 ◽

2019 ◽

Vol 56 (1) ◽

pp. 40

Author(s):

B. P. Pushpa ◽

C. Kempanna

Keyword(s):

Sodium Chloride ◽

Potassium Chloride ◽

Cheese Whey ◽

Trisodium Citrate ◽

Oral Rehydration Salt ◽

World Health ◽

Oral Rehydration ◽

Orange Colour ◽

Paneer Whey ◽

Health Organization

In the present study, development of electrolyte drinks from paneer and cheese whey was carried out by enzymatic hydrolysis of lactose to simple sugars and formulating the sugar to salt ratio to meet the World Health Organization (WHO) requirements (245 mOsmol/L) for Oral Rehydration Salt (ORS). Lactose hydrolyzed whey was diluted (1: 2.3 v/v) using potable quality demineralised water to achieve reduction in osmolarity of 75 mOsmol/L. The salt concentration was adjusted by adding 3.25 g sodium chloride and 0.8 g potassium chloride for paneer whey (per L) and 2.5 g sodium chloride, 0.9 g of potassium chloride and 1.5 g of trisodium citrate for cheese whey (per L) to meet Na, K and citrate levels in the resultant whey drink as per WHO requirement. Other additives used in developing hypotonic electrolyte whey drink from lactose hydrolyzed whey systems were sucralose (sweetener), citric acid (acidulant), orange flavour and orange colour. The formulated hypotonic electrolyte whey based drink had significantly higher sensory scores when compared to the scores of two commercial orange flavour ORS drinks. Cheese whey based electrolyte drink was superior over paneer whey based electrolyte drink in sensory characteristics; former drink had better consistency and mouth feel.

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Comparison of Two Criteria of Weight Gain Adequacy During Pregnancy in Relation to Anthropometric Indices in Uruguayan Young Children

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_129 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1057-1057

Author(s):

Lucía Pienovi ◽

Carmen Donangelo ◽

Cecilia Severi

Keyword(s):

Weight Gain ◽

Growth Patterns ◽

World Health ◽

Institute Of Medicine ◽

Maternal Weight ◽

Pregnancy Weight Gain ◽

Anthropometric Indices ◽

Health Organization ◽

Pregnancy Weight ◽

Weight Gain During Pregnancy

Abstract Objectives To compare the relationship between maternal weight gain during pregnancy and anthropometric indices of Uruguayan children under 4 years examined by two different criteria for adequate pregnancy weight gain: Atalah et al. (AEA) widely used in Latin America and Institute of Medicine (IOM). Methods Descriptive study of data from the First National Survey of Child Health, Nutrition and Development of Uruguay (ENDIS) of children (n = 1602; age 24.3 ± 10.6 months) recruited in 2013. Weight and height of the children were measured. Child birth weight (BW) and pregnancy weight gain (PregWG) were reported at the interview. PregWG was classified as adequate or excessive according to AEA and IOM criteria. Z scores for weight-for-age (WAZ), height-for-age (HAZ), weight-for-height (WHZ) and body mass index-for-age (BAZ) of the children were obtained from the Growth Patterns of World Health Organization. Results Prevalence of excessive PregWG was higher based on AEA (51.2%) compared to IOM (38.9%) criteria (P < 0.001). Excessive PregWG was associated with higher child BW compared to adequate PregWG using both criteria (AEA: 3361 ± 525 g and 3203–550 g, IOM: 3379 ± 543 g and 3224–534 g, respectively) (P < 0.001). Prevalence of macrosomic BW (>4000 g) with excessive PregWG was similar using AEA (10%) and IOM (12%). WAZ was higher with excessive compared to adequate PregWG using AEA (0.52 ± 1.07 and 0.32 ± 1.66, respectively) (P < 0.005) but not different by using IOM (0.51 ± 1.08 and 0.37 ± 1.55, respectively) (P = 0.057). HAZ was lower with excessive compared to adequate PregWG based on AEA (−0.4 ± 1.12 and −0.23 ± 1.10, respectively) (P = 0.001) but not different based on IOM (−0.7 ± 1.15 and −0.18 ± 1.09, respectively) (P = 0.057). WHZ and BAZ did not differ by PregWG categories using AEA or IOM. Conclusions Prevalence of excessive weight gain during pregnancy was higher using AEA compared to IOM criteria. However, only subtle differences in the associations between adequacy of pregnancy weight gain and child anthropometric indices were observed when using AEA or IOM criteria. Funding Sources Instituto Nacional de Estadística, Uruguay.

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Antibiotic prescriptions in the case management of acute watery diarrhea in under fives

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20171685 ◽

2017 ◽

Vol 4 (3) ◽

pp. 691 ◽

Cited By ~ 1

Author(s):

Ekong E. Udoh ◽

Martin M. Meremikwu

Keyword(s):

Health Workers ◽

Sampling Technique ◽

World Health ◽

Watery Diarrhea ◽

P Value ◽

Oral Rehydration ◽

Cross River State ◽

Multi Stage ◽

Acute Watery Diarrhea ◽

Health Organization

Background: Diarrhea disease is a leading cause of under-five mortality globally. The World Health Organization recommends low osmolality oral rehydration solution, zinc supplementation and adequate nutrition in the management. Antibiotic is indicated only in specific circumstances. This study was aimed at determining the antibiotic prescription in the management of under-fives with acute watery diarrhea.Methods: An audit of under-fives managed for acute watery diarrhea was conducted between January and February 2012. A multi-stage stratified random sampling technique was used to select 32 health facilities (21 primary and 11 secondary) from two local government areas of Cross River State. Case records of children managed for the condition six months prior to the audit were retrieved and evaluated. The appropriateness, types and frequency of antibiotic prescriptions were assessed.Results: A total of 370 case records were evaluated. Antibiotic was not indicated in any of the children but was prescribed for 291 (78.6%). Of this number, 169 (45.7%) received one antibiotic while 122 (33.0%) received two or more antibiotics. The difference in the prescription of multiple antibiotics between health workers in the primary and secondary facilities was statistically significant (p value = 0.00001). Metronidazole was the most prescribed antibiotic 228 (50.9%), followed by co-trimoxazole 88 (19.6%) and gentamicin 55 (11.8%).Conclusions: There is a high level of irrational antibiotic prescriptions in the State with oral metronidazole being the most prescribed. Periodic training of health workers on indications for antibiotic prescriptions in the management of diarrhea in under-fives is necessary.

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Use of Nonhuman Milks in the Dietary Management of Young Children With Acute Diarrhea: A Meta-Analysis of Clinical Trials

PEDIATRICS ◽

10.1542/peds.93.1.17 ◽

1994 ◽

Vol 93 (1) ◽

pp. 17-27

Author(s):

Kenneth H. Brown ◽

Janet M. Peerson ◽

Olivier Fontaine

Keyword(s):

Clinical Trials ◽

Young Children ◽

Treatment Failure ◽

Acute Diarrhea ◽

Randomized Clinical Trials ◽

World Health ◽

Milk Formula ◽

Failure Rates ◽

Treatment Protocols ◽

Oral Rehydration

Objective. To assess the effects of continued feeding of nonhuman milks or formulas to young children during acute diarrhea on their treatment failure rates, stool frequency and amount, diarrheal duration, and change in body weight. Methods. A total of 29 randomized clinical trials of 2215 patients were identified by computerized bibliographic search and review of published articles. Data were abstracted and analyzed using standard meta-analytic procedures. Results. Among studies that compared lactose-containing milk or formula diets with lactose-free regimens, those children who received the lactose-containing diets during acute diarrhea were twice as likely to have a treatment failure as those who received a lactose-free diet (22% vs 12%, respectively; P < .001). However, the excess treatment failure rates occurred only in those studies that included patients whose initial degree of dehydration, as reported by authors, was severe, or that were conducted before 1985, when appropriate diarrhea treatment protocols were first widely accepted. Among studies of patients with mild diarrhea, all but one of which were completed after 1985, the overall treatment failure rates in the lactose groups were similar to the rates in the lactose-free groups (13% vs 15%). These results suggest that children with mild or no dehydration and those who are managed according to appropriate treatment protocols, such as that promoted by the World Health Organization, can be treated as successfully with lactose-containing diets as with lactose-free ones. The pooled information from studies that compared undiluted lactose-containing milks with the same milks offered at reduced concentration concluded that (1) children who received undiluted milks were marginally more likely to experience treatment failure than those who received diluted milk (16% vs 12%, P = .05), (2) the differences in stool output were small and of limited clinical importance, and (3) children who received the undiluted milk diets gained 0.25 SD more weight than those who received the diluted ones (P = .004). In addition, as with the previous set of studies, there were no differences in the pooled treatment failure rates between the respective groups in those studies of mildly dehydrated patients conducted after 1985 (14% vs 12%). Conclusions. The vast majority of young children with acute diarrhea can be successfully managed with continued feeding of undiluted nonhuman milks. Routine dilution of milk and routine use of lactose-free milk formula are therefore not necessary, especially when oral rehydration therapy and early feeding (in addition to milk) form the basic approach to the clinical management of diarrhea in infants and children.

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Diarrhea Care in Private Practice

PEDIATRICS ◽

10.1542/peds.89.5.980 ◽

1992 ◽

Vol 89 (5) ◽

pp. 980-980

Author(s):

MARK L. TOCHEN ◽

DON TSUKAMAKI

Keyword(s):

Kansas City ◽

Oral Rehydration Solution ◽

Oral Rehydration Therapy ◽

World Health ◽

Oral Rehydration ◽

Rehydration Solutions ◽

The Us ◽

The World ◽

Rehydration Solution ◽

Health Organization

To the Editor.— The article by Dr Snyder, "Use and Misuse of Oral Rehydration Therapy for Diarrhea,"1 led us to review our treatment of gastroenteritis, revise our telephone protocols, and seek out rehydration solutions. Our difficulty in obtaining adequate supplies mirrored that of Dr O'Banion.2 Expense to the patient is also an important factor: commercial premixed solutions sell for $4 to $6 per quart in our area, which many families cannot pay. Our solution was to obtain from the World Health Organization the name of the US supplier of oral rehydration solution (ORS) packets and order direct from the supplier (Jianas Bros Packaging Co, 2533 SW Blvd, Kansas City, MO 64108).

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Obesity as an infectious disease– review of the literature

Diagnostyka Laboratoryjna ◽

10.5604/01.3001.0004.1323 ◽

2015 ◽

Vol 51 (1) ◽

pp. 53-58

Author(s):

Iwona Bil-Lula ◽

Anna Krzywonos-Zawadzka

Keyword(s):

Weight Gain ◽

Environmental Factors ◽

World Literature ◽

Bacterial Infections ◽

Body Weight Gain ◽

Therapeutic Strategies ◽

World Health ◽

The Central Nervous System ◽

Health Organization ◽

Intensive Work

Obesity, which is a pathological and excessive accumulation of body fat (WHO; World Health Organization), is the problem undertaken in the world literature for several decades. Significant mortality due to the obesity comorbidities is the basis to undertake an intensive work on the new preventive and therapeutic strategies worldwide. Nevertheless, due to the multifactorial origin of obesity and the growing number of obese subjects, the effectiveness of these strategies appears to be highly limited. Besides to the traditionally recognized etiological factors of obesity, many reports showing an association of infectious agents and uncontrolled weight gain have been published recently. In this paper we present an overview of reports confirming the association between infections and obesity. Data showed that a specific viral and bacterial infections as well as infections with protozoa and prions are associated with the increased intracellular accumulation of lipids, hypertrophy and hyperplasia of adipose tissue, body weight gain, increase of BMI and changes in lipid metabolism. These infections can serve as direct causal agents, but they can also interact with other environmental factors, thus increasing the predisposition to the development of obesity. There are at least a few hypotheses on the pathogenesis of “infectobesity.” There are some reports describing the damage of the central nervous system and hence the endocrine glands dysfunction due to infection, increased insulin susceptibility of infected cells, reduced production and release of leptin, increased glucose and fatty acids transport into adipocytes and inflammatory basis for infectobesity. Undoubtedly, awareness of the relationship between infections and obesity brings us closer to develop the effective preventive and therapeutic strategies, but it also raises the question about other, so far underestimated, environmental factors that increase the predisposition to obesity.

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Prevalence and type of anaemia in female cotton mill workers in Beijing, China

British Journal Of Nutrition ◽

10.1079/bjn19930174 ◽

1993 ◽

Vol 70 (3) ◽

pp. 787-796 ◽

Cited By ~ 6

Author(s):

Ruowei Li ◽

Xue-Cun Chen ◽

Huai-Cheng Yan ◽

Paul Deurenberg ◽

Lars Garby ◽

...

Keyword(s):

Total Population ◽

Response Rate ◽

Placebo Treatment ◽

Treated Group ◽

Mean Value ◽

World Health ◽

Female Workers ◽

The Mean ◽

Health Organization ◽

Beijing China

The present study investigates the prevalence and type of anaemia in Chinese female cotton mill workers. The prevalence of anaemia is reported in 447 non-pregnant female workers aged between 19 and 45 years. The mean value for haemoglobin (Hb) was 123 (SD 15) g/l and 150 of the total 447 subjects had Hb values below 120 g/l; thus 34% of the population was anaemic according to World Health Organization (WHO, 1975) criteria. The mean value for free erythrocyte protoporphyrin (FEP) was 419 (SD 215) μg/l; 55% of the total population had FEP values higher than 350 μg/l and 72% among the anaemic subjects. Serum ferritin (SF) was tested in all the women with a Hb value less than 120 g/l and 71 % of them had SF values below 12·0 μg/ls. Eighty women diagnosed as either Fe deficient or with Fe-deficient anaemia were selected for a diagnostic supplementation trial. They were randomly assigned to FeSO4(60 or 120 mg Fe/d) or placebo treatment for 12 weeks. Fe supplementation increased mean Hb values from 114 to 127 g/l (P< 0·001) and SF levels from 9·7 to 30·0 μg/l (P< 0·001), and decreased mean FEP values from 570 to 277 μg/l (P< 0·001). The response rate of Hb in the whole Fe-treated group or Fe-treated subjects with an Hb level less than 120 g/1 was 90 % or 92 % respectively. These findings indicate that the type of anaemia in this population was mainly Fe deficiency. It was also found that in this population the severity of anaemia, not the prevalence, was significantly related to the use of intra-uterine devices (IUD).

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Osmolality of Commercially Available Oral Rehydration Solutions: Impact of Brand, Storage Time, and Temperature

Nutrients ◽

10.3390/nu11071485 ◽

2019 ◽

Vol 11 (7) ◽

pp. 1485 ◽

Cited By ~ 1

Author(s):

Kurt J. Sollanek ◽

Robert W. Kenefick ◽

Samuel N. Cheuvront

Keyword(s):

Shelf Life ◽

Elevated Temperatures ◽

World Health ◽

Prolonged Storage ◽

Oral Rehydration ◽

Mixed Solutions ◽

Rehydration Solutions ◽

Before And After ◽

Shelf Life Stability ◽

Health Organization

Oral rehydration solutions (ORS) are specifically formulated with an osmolality to optimize fluid absorption. However, it is unclear how many ORS products comply with current World Health Organization (WHO) osmolality guidelines and the osmotic shelf-life stability is not known. Therefore, the purpose of this investigation was to examine the within and between ORS product osmolality variation in both pre-mixed and reconstituted powders. Additionally, the osmotic stability was examined over time. The osmolality of five different pre-mixed solutions and six powdered ORS products were measured. Pre-mixed solutions were stored at room temperatures and elevated temperatures (31 °C) for two months to examine osmotic shelf stability. Results demonstrated that only one pre-mixed ORS product was in compliance with the current guidelines both before and after the prolonged storage. Five of the six powdered ORS products were in compliance with minimal inter-packet variation observed within the given formulations. This investigation demonstrates that many commercially available pre-mixed ORS products do not currently adhere to the WHO recommended osmolality guidelines. Additionally, due to the presence of particular sugars and possibly other ingredients, the shelf-life stability of osmolality for certain ORS products may be questioned. These findings should be carefully considered in the design of future ORS products.

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