1.3. Malabsorption

The significant decrease in absorption of nutrients with diarrhea is referred to above. In the metabolic studies of INCAP protein absorption was generally reduced 10 to 30% and rarely as much as 40%. However, the frequency of diarrhea! disease in young children makes this a significant contribution to the frequent periods of decreased energy intake in young children due to infections. POWANDA (1977) has summarized additional literature and attempted to quantitate the range of malabsorption of protein, fat and carbohydrate with diarrhea.

Despite the reduced absorption it is important to maintain food intake to the extent possible during bouts of diarrhea. CHUNG and VISCOROVA (1948) reported that the absorption of nitrogen in four children with diarrhea varied from 40 to 74% and that of fat from 39 to 67%. For two similar cases in which food was withheld, absorption percentages were mildly depressed for both nitrogen and fat. Data from ICDDRB for diarrhea due to rotavirus average 43% for nitrogen, 42% for fat, 74% for carbohydrate and 55% for total calories. Corresponding figures for diarrhea due to enteropathogenic E. coli and Shigella were slightly higher (MOLLA et al., 1982).

The range of infections that are associated with malabsorption is wide and most are common in developing countries. They include the bacterial, viral and protozoan enteritides, intestinal parasites such as hookworm, fish tapeworm, ascaris, strongyloides; and systemic disorders such as measles, tuberculosis and streptococcal infections. These infections act by shortening intestinal transit time or by physical blocking of mucosal surfaces.