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persistent diarrhea in children. Pediatrics 1991;88:1010— 1018; persistent diarrhea, khitchri, dietary therapy. ABBREVIATIONS. PD, persistent diarrhea; NICH, National In stitute of Child Health. Despite major advances in the knowledge and use oforal rehydration therapy,' diarrheal diseases con tinue to be one of the main causes of mortality and morbidity in the developing world.2 Persistent diar rhea (PD; defined as diarrhea lasting more than 2 weeks usually with weight loss) is receiving increas ing attention because more than one third of all diarrhea-associated deaths may be related to PD, with case-fatality rates as high as 14%[email protected] Although the pathogenesis of PD remains un known, a close relationship between PD and ma! nutrition has been identified.4'5 There is evidence that malnutrition itself predisposes to PD,6 and in the developing world the two almost universally coexist in affected children. Persistent diarrhea has, therefore, been viewed by some as a nutritional disorder,7'8 and nutritional rehabilitation may well play an integral role in its successful management.8 The optimal form of nutritional therapy, whether enteral or parenteral, has not yet been identified. The enteral route has the potential advantages of decreased expense, far greater availability, and lower risk of infection. Recent studies have also demonstrated that enteral feeding may result in faster recovery and shortened duration of hospital ization compared with parenteral nutrition.9 ABSTRACT.Recent studies have indicatedthat enteral diets can play an important role in the treatment of persistent diarrhea. Khitchri, a local weaning food in Pakistan, is composed of rice and lentils, which have previously been shown to be well tolerated in many children with acute diarrhea. The effectiveness of a khitchri and yogurt (KY) diet, which is inexpensive and widely available in Pakistan, was studied. One hundred two weaned boys (6 to 36 months old) with persistent diarrhea were randomly assigned to receive either soy formula (group A) or the KY diet (group B) for 14 days. Group A also received the KY diet in addition to formula for days 8 through 14. Twenty-nine children did not complete the study because of severe infection (13) or their family's decision to leave the study early (9 in group A and 7 in group B). Sixty-six children successfully completed the study protocol; there were five clinical failures in group A and two in group B. On a comparable caloric intake, there was a significantly lower stool vol ume (group B: 38 ±16 [mean ±SDI vs group A: 64±75 g/kg per day, P < .05) and frequency (B: 4.4 ±2.0 vs. A: 6.6 ±4.2 stools per day, P < .005) in children fed KY during the first week of therapy. Group B children also had a significantly greater weight gain than children in group A during the first week (B: 468 ±373 g/wk vs A: 68 ±286 g/wk, P < .005).The addition of KY to the diet of the soy-fed group in the second week of therapy resulted in a significantly greater weight gain compared with the first week (575 ±408 g/wk, P < .005). These
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  • Fall '09
  • Oral rehydration therapy

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