Amadi Beatrice, Mwiya Mwiya, Chomba Elwyn, Thomson Mike, Chintu Chifumbe, Kelly Paul, Walker-Smith John
Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia.
J Trop Pediatr. 2005 Feb;51(1):5-10. doi: 10.1093/tropej/fmh064. Epub 2004 Dec 15.
The persistent diarrhoea-malnutrition syndrome (PDM) remains a leading cause of morbidity and mortality in hospitals in resource-poor countries. In view of the benefits of elemental or oligomeric feeds in inflammatory bowel diseases, we performed a randomized controlled trial of an exclusive diet of amino acid-based elemental feed (AAF) compared with standard nutritional rehabilitation (based on skimmed milk and then soya) for PDM. Treatment was given for 4 weeks in the malnutrition ward of the University Teaching Hospital, Lusaka, in a single-blind study. Intestinal and systemic infections were treated with routine therapies. The main outcome measures were weight gain, recovery from diarrhoea, and mortality. Two hundred children (106 HIV seropositive, 90 HIV seronegative) were randomized; 155 children completed therapy, 39 died, and six were lost to follow-up. At randomization, they were severely malnourished: median baseline weight-for-age z-score was -4.0 (interquartile range, IQR -4.4, -3.5); 9 per cent were underweight, 23 per cent had marasmus, 47 per cent had kwashiorkor, and 21 per cent had marasmic-kwashiorkor. Weight gain was greater in the AAF group (median gain in weight-for-age z-score was 1.23, IQR 0.89-1.57) compared with the control group (0.87, IQR 0.47-1.25; p=0.002), although calorie intakes were higher in the control group. The increase in haemoglobin concentration was also greater in the AAF group (0.8 g/dl, IQR 0-1.8) than in the control group (0.3, IQR -0.6, -1.6; p=0.04). Diarrhoea frequency and global recovery scores improved equally in both treatment groups and mortality did not differ. A diet of reduced molecular complexity was associated with significantly improved weight gain.
持续性腹泻-营养不良综合征（PDM）仍是资源匮乏国家医院中发病和死亡的主要原因。鉴于要素或低聚饲料对炎症性肠病有益，我们针对PDM开展了一项随机对照试验，将基于氨基酸的要素饲料（AAF）独家饮食与标准营养康复治疗（基于脱脂牛奶，然后是大豆）进行比较。在卢萨卡大学教学医院的营养不良病房进行了一项单盲研究，治疗为期4周。肠道和全身感染采用常规疗法治疗。主要结局指标为体重增加、腹泻恢复情况和死亡率。200名儿童（106名HIV血清阳性，90名HIV血清阴性）被随机分组；155名儿童完成治疗，39名死亡，6名失访。随机分组时，他们严重营养不良：年龄别体重中位数z评分是-4.0（四分位间距，IQR -4.4，-3.5）；9%体重不足，23%患有消瘦症，47%患有夸希奥科病，21%患有消瘦型夸希奥科病。与对照组（0.87，IQR 0.47-1.25；p=0.002）相比，AAF组年龄别体重z评分的中位数增加更大（1.23，IQR 0.89-1.57），尽管对照组的热量摄入量更高。AAF组血红蛋白浓度的增加（0.8 g/dl，IQR 0-1.8）也高于对照组（0.3，IQR -0.6，-1.6；p=0.04）。两个治疗组的腹泻频率和总体恢复评分均有同等程度改善，死亡率无差异。分子复杂性降低的饮食与体重增加显著改善相关。
