Effects of a protein-rich diet during convalescence from shigellosis on catch-up growth, serum proteins, and insulin-like growth factor-I

Abstract

Shigellosis in children can cause growth retardation, worsening of malnutrition, and hypoproteine-mia. To assess the effects of ingestion of a protein-rich diet during convalescence, 22 children aged 2 to 4 y with culture-proven shigellosis were randomly assigned after 5 d of antibiotic treatment to 21-d feeding regimens of either a 150 kcal/kg/d high-protein diet with 15% of calories as protein or an isocaloric control diet with 6% of calories as protein. At the start and end of dietary treatment, weight, height, mid-arm circumference, skinfold thickness, serum protein concentrations, and serum IGF-I were measured. Means of weight gain and increases in mid-arm circumfer­ence were greater in children fed high-protein diets than those fed control diets (1.23 versus 0.76 kg; 1.40 versus 0.96 cm; p < 0.05). Mean increase in height in children fed high-protein diets (0.83 cm) was not significantly greater than with control diets (0.74 cm). Mean increases in serum concentrations of total protein, prealbumin, and retinol-binding protein were greater in the high-protein group than in controls (p < 0.05). Mean serum concentra­tions of IGF-I were low in both groups before treatment [4.2 ± 2.6 nmol/L (31.9 ± 19.6 ng/mL) in controls; 3.1 ± 3.4 nmol/L (24.0 ± 26.3 ng/mL) in the high-protein group] but increased more in the high-protein group [39.0 ± 16.2 nmol/L (298 ± 124 ng/mL)] than in the control group [16.7 ± 9.2 nmol/L (128 ± 70 ng/mL), p < 0.01]. These results suggest that high dietary protein is more effective than a normal protein intake in repleting body proteins and in stimulating growth after shigellosis in children. A possible mechanism for this stimulatory effect on growth may be through the restoration of IGF-I. © 1992 International Pediatric Research Foundation, Inc.