Effect of milk-containing diets on the severity and duration of childhood diarrhea

Milk Transmission of HTLV-1 and the Need for Innovative Prevention Strategies

Breastfeeding is recommended by the World Health Organization for at least 6 months up to 2 years of age, and breast milk protects against several diseases and infections. Intriguingly, few viruses are transmitted via breastfeeding including Human T-cell leukemia virus Type 1 (HTLV-1). HTLV-1 is a highly oncogenic yet neglected retrovirus, which primarily infects CD4+ T-cells in vivo and causes incurable diseases like HTLV-1-associated inflammatory conditions or Adult T-cell leukemia/lymphoma (ATLL) after lifelong viral persistence. Worldwide, at least 5–10 million people are HTLV-1-infected and most of them are unaware of their infection posing the risk of silent transmissions. HTLV-1 is transmitted via cell-containing body fluids such as blood products, semen, and breast milk, which constitutes the major route of mother-to-child transmission (MTCT). Risk of transmission increases with the duration of breastfeeding, however, abstinence from breastfeeding as it is recommended in some endemic countries is not an option in resource-limited settings or underrepresented areas and populations. Despite significant progress in understanding details of HTLV-1 cell-to-cell transmission, it is still not fully understood, which cells in which organs get infected via the oral route, how these cells get infected, how breast milk affects this route of infection and how to inhibit oral transmission despite breastfeeding, which is an urgent need especially in underrepresented areas of the world. Here, we review these questions and provide an outlook how future research could help to uncover prevention strategies that might ultimately allow infants to benefit from breastfeeding while reducing the risk of HTLV-1 transmission.

Oral rehydration solution therapy in the management of children with rotavirus diarrhea

Rotavirus infections are the most common cause of gastroenteritis among children younger than 3 years of age and are associated with sporadic outbreaks of diarrhea in elderly and immunocompromised patients. Oral rehydration solutions (ORS) are formulated to correct dehydration and acidosis. Currently, ORS do not promote intestinal healing; however, investigators are examining the role of nutrition in promoting intestinal healing. This article reviews the composition of several ORS in human medicine and summarizes our current knowledge of the nutritional treatment of rotavirus diarrhea and intestinal healing.

Inequality in infant morbidity: causes and consequences in England in the 1990s. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood

STUDY OBJECTIVE

To examine the effect of deprivation, crowding, maternal smoking, and breast feeding on morbidity from wheeze and diarrhoea in the first six months after birth.

DESIGN

A geographically located population survey using maternal responses on self completion questionnaires.

SETTING

The three health districts of Bristol.

SUBJECTS

8501 infants from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) in which all women expecting a baby between April 1991 and December 1992 in Bristol were invited to participate.

MAIN OUTCOME MEASURES

The prevalence and severity of wheeze at six months after birth. The prevalence of diarrhoea and the duration of the worst bout at six months after birth.

RESULTS

Logistic regression analyses using a conceptual hierarchical framework showed that wheeze was significantly more likely to be reported for infants if they lived in rented accommodation (OR = 1.20, 95% CI = 1.04, 1.39), if they lived in crowded housing conditions (OR = 1.26, 95% CI = 1.06, 1.49), if they were one of a number of siblings (OR = 1.78, 95% CI = 1.52, 2.07), and if their mothers smoked (OR = 1.38, 95% CI = 1.21, 1.58). They were significantly less likely to have wheeze if they were breast fed (OR = 0.68, 95% CI = 0.59, 0.79). Each of these factors was independently related to the prevalence of wheeze. For infants with wheeze those who were breast fed for three or more months were significantly less likely to have three or more episodes in the first six months after birth (OR = 0.76, 95% CI = 0.58, 0.99). A higher prevalence of diarrhoea in infancy was associated with living in rented accommodation (OR = 1.25, 95% CI = 1.10, 1.41) and lower maternal education (OR = 0.76, 95% CI = 0.69, 0.84) and a lower prevalence with breast feeding (OR = 0.42, 95% CI = 0.37, 0.48). An episode of diarrhoea was significantly less likely to last for six or more days if an infant lived in mortgaged accommodation (OR = 1.34 95% CI = 1.03, 1.75) and was breast fed for three or more months (OR = 1.34 95% CI = 1.03, 1.75).

CONCLUSION

Deprivation was associated with heightened morbidity from common conditions such as wheeze and diarrhoea for this geographical cohort of infants in England in the 1990s. Results supported evidence suggesting that breast feeding is protective against such conditions and is particularly associated with reduced severity and duration. Implications for future research and policy are discussed.

Treatment of acute diarrhoea in practice

The recommended treatment for acute diarrhoea includes oral rehydration and rapid refeeding is increasingly recommended. The objective of this study was to assess the home use of oral rehydration, and rehydration and realimentation in hospital. The parents of children (aged less than 4 y) with acute diarrhoea answered questions on supplementary fluids and diet during the current diarrhoea at home (n = 129). The admitted patients (n = 60) were weighed daily and food consumption was measured (consecutive 3-d food record). Oral rehydration had been attempted in 67% of the children managed at the outpatient department and in 65% of those admitted. The total energy intake was on average 697 kcal (95% confidence interval 639-755), which is two-thirds of that recommended for the age group. Oral rehydration has become accepted in the management of acute diarrhoea, while rapid realimentation is not yet equally endorsed.

Gastroenteritis, diarrhoea and breast feeding

In this paper we review the literature in regard to possible relationships between breast feeding and diarrhoea or gastroenteritis. We show that in the developed as well as the developing world, there is consistent evidence of a protective effect of exclusive breast feeding in the first 4-6 months of life. The odds ratios were generally in excess of 3.0 for non-breast milk feeds. The relationship was not consistent for rotavirus infections but was consistently strong for non-viral pathogens. There are a number of indicators that suggest biological plausibility, in both the developing and developed world. The triple indicators of consistency and strength of the epidemiological associations, together with biological plausibility are major arguments for believing that there is a causal sequence involved.