Breast-feeding, weaning and the diarrhoeal syndrome in a Guatemalan Indian village

Abstract

Prospective studies in Mayan Indian children living in their natural setting were carried out from 1964 through 1974; observations began at birth and extended at least throughout the first three years of life. Adequate growth and survival were characteristic of exclusively breast-fed infants in the first months of life. Despite the high rate of infection, children exhibited a considerable resistance to intestinal protozoa, enterobacteriaceae and enteric viruses. Resistance against colonic invaders is attributed to the bifidus flora, and that against agents acting in the small bowel, to specific antibodies present in colostrum and milk. Diarrhoeal disease was least in this period and increased with weaning to reach maximum peaks at the time of weaning. The protracted weaning consisted of progressive administration of foods of low biological value given under deficient sanitary conditions. The nutrient value of the diet as a function of the child's weight was adequate in protein but in most cases it was markedly deficient in calories. Infectious diseases, particularly diarrhoea, were found associated with pronounced reductions in the already deficient calorie intake. Infection and infectious disease were common particularly during the first 6 to 18 months of life. Weight loss was a frequent finding during and after episodes of disease. The consequence of the malnutrition-infection interaction is a marked stunting of growth, clearly evident from examination of the growth curves of village children.Nutrient intake did not correlate with growth velocity. By contrast, the duration of breast-feeding was strongly associated with growth in the linear segment of the curve, while in the period of faster growth the correlation was inverse. On the other hand, morbidity was inversely correlated with calorie and protein intake and this was more obvious in the second than in the first year of life. The data indicate that infection is one of the leading factors associated with reduced calorie (and protein) intakes during the critical period of onset of malnutrition and mortality in childhood. By preventing infection, particularly diarrhoea, the food intake, nutrition and growth of children could be significantly improved.Diarrhoeal diseases still rank among the leading reported causes of childhood morbidity and mortality in nations where malnutrition and deficient hygiene prevail. The inter-American investigation of childhood mortality by the Pan American Health Organization revealed that malnutrition frequently underlies deaths due to diarrhoea and other communicable diseases (Puffer & Serrano 1973). This interrelation was recognized as a syndrome, 'weanling diarrhoea', many years ago in infants and small children (Gordon et al. 1963). The interdependence of weanling diarrhoea with the particular pattern of weaning is evident from the varying age of occurrence of the peak of diarrhoea in various geographical regions. Weanling diarrhoea appears early with early weaning and late when breast-feeding is prolonged. In early diarrhoea the probability of severe malnutrition and premature death and other sequelae is greater than when weaning is late. Prolonged weaning, nevertheless, is associated with malnutrition and mortality. Numerous investigations have failed to show conclusively a satisfactory aetiological explanation for the endemic diarrhoeas, although epidemiological