Childhood chronic non-specific diarrhea, gastrointestinal transit time, and dietary intake

Chronic non-specific diarrhea (CNSD) is one of the most common problems seen by pediatric physicians. Its assessment, health consequences, and relationship to dietary practice have not been well-studied The influence of dietary intake on transit time was evaluated for eleven children aged 12 to 36 months (average of 22) with and without CNSD, based on standard clinical criteria. These children were part of a study to compare methods of quantifying gastrointestinal transit using five different radiopaque pellets (30 each) and X-rayed stools. Traditional adult dosing regimens of pellets at 24 hr intervals was inappropiate for children of this age. Dosing at 12 hr intervals resulted in significantly longer transit times by most measures (in hrs, MMT-C; 16.4 vs. 41.6, MMT-S; 38.0 vs 50.6 and, 50TT; 19.9 vs 46.6). Steady state was never reached with the 24 hr regimen. Their was a tendency for shorter transit times in children with CNSD. Four 24-hr diet records and questionnaire were used for data collection and nutrient intake of energy, fat, dietary fiber, iron, water, dry matter, fresh food weight, fructose and lactose. These were analyzed using Nutritionist IV. The only significant difference was seen with energy intake Dietary fiber intake was 5.2g/1000 kcal and according to NHANES II data children over 2y of age consume 6g/1000 kcal. Therefore, the children in both groups in this study were consuming slightly less dietary fiber than the overall population in this age group, but it was not related to the CNSD. Total energy intake was greater for the CNSD group (1403.3 ± 101.3 vs. 1114 ± 50.8 kcal/d, P<0.01). The CNSD group was consuming 12% more energy than their RDA. Total calories from fat was not different, even though fat intake was almost significantly greater for the CNSD group (P<0.09). Increasing fat intake has been suggested to reduce CNSD. The children with CNSD were significantly taller, but not heavier, and therefore were leaner despite their greater energy intake. Physiologically, this appears logical as the children with CNSD require greater energy intake to maintain body weight to make up for energy and nutritents not absorbed.