Sullivan P B
Department of Paediatrics, University of Oxford, John Radcliffe Hospital, UK.
Nutrition. 1998 Oct;14(10):758-62. doi: 10.1016/s0899-9007(98)00078-1.
Despite recommendations from several bodies such as the World Health Organization and others that feeding should be continued during diarrhea, the practice of withholding food during the early stages of diarrhea is still widespread. This contributes to a deterioration in patients' nutritional state. The principal controversy in the nutritional therapy of acute gastroenteritis centers on the relative risks of cows'-milk feeds. The two things that need to be considered in determining the optimum approach to feeding the child with acute diarrhea are the optimum timing for feeding children in relation to the onset of and recovery from symptoms and, secondly, the effects of specific food ingredients in the diet. Recent studies have demonstrated that the vast majority of young children with acute diarrhea can be successfully managed with continued feeding of undiluted non-human milk. Routine dilution of milk and routine use of lactose-free formula are 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 children. Confounding factors are the severity of the diarrhea, coexistent malnutrition, and young age (< 1 y); such infants are much more likely to have complications from early feeding with undiluted milk and some would advocate use of specifically designed lactose-free formula in such children. Children who are fed exclusively with human milk and those who receive solid foods with or without human milk may safely continue to receive their usual diets during diarrhea. Those who are fed exclusively with non-human milk--especially when very young and with severe diarrhea or malnutrition--should be closely observed if they continue to consume milk or they should receive a special formulation (e.g., a cereal-milk mixture or fermented milk product). The use of nutrient-dense mixtures of common foods may be advisable to promote compensatory growth in those who lose weight during illness or because of anorexia or malabsorption.
尽管世界卫生组织等多个机构建议腹泻期间应继续喂养，但在腹泻早期阶段禁食的做法仍然普遍存在。这会导致患者营养状况恶化。急性肠胃炎营养治疗的主要争议集中在牛奶喂养的相对风险上。在确定喂养急性腹泻儿童的最佳方法时，需要考虑的两件事是：与症状发作和恢复相关的儿童最佳喂养时间，其次是饮食中特定食物成分的影响。最近的研究表明，绝大多数急性腹泻幼儿通过持续喂养未稀释的非母乳能够成功得到治疗。常规稀释牛奶和常规使用无乳糖配方奶粉没有必要，尤其是当口服补液疗法和早期喂养（除牛奶外）构成儿童腹泻临床管理的基本方法时。混杂因素包括腹泻的严重程度、并存的营养不良和低龄（<1岁）；这类婴儿更有可能因早期喂养未稀释牛奶而出现并发症，一些人主张在此类儿童中使用专门设计的无乳糖配方奶粉。纯母乳喂养的儿童以及接受或不接受母乳的固体食物喂养的儿童在腹泻期间可以安全地继续食用他们平常的饮食。纯非母乳喂养的儿童——尤其是非常年幼且患有严重腹泻或营养不良的儿童——如果继续食用牛奶，应密切观察，或者他们应该接受特殊配方（例如谷物 - 牛奶混合物或发酵奶制品）。对于那些在患病期间因厌食或吸收不良而体重减轻的人，使用营养丰富的常见食物混合物可能有利于促进代偿性生长。
