Malabsorption of Nutrients

Malabsorption in diarrheal illness may result from the epithelial destruction by the pathogen. Diminished nutrient absorption often begins during acute diarrhea. At this time, the body is less able to absorb needed macronutrients, including fats and proteins, as well as some carbohydrates. This is most severe in undernourished children who suffer from persistent diarrhea due to damage to the gut epithelium. When the gut is damaged, food is not properly digested or absorbed. The causes of insufficient nutrient absorption include diminished concentration of bile acids, which are used for fat absorption; damaged epithelial cells, which provide the absorptive surface on the bowel; and a deficiency of disaccharides due to damaged microvilli, which normally produce the needed enzymes. In symptomatic rotavirus infection, the most common cause of acute severe diarheal illness worldwide, there is a 42% decrease in the absorption of nitrogen and fat, a 48% decrease in absorption of carbohydrates, and a 55% decrease in the total carbohydrate absorption. Malabsoption is more severe in both ETEC and shigella diarrhea. In shigellosis, loss of protein and vitamin A is sizeable. Giardiasis leads to malabsorption of vitamin A. A large amount of zinc is lost in diarrhea, usually resulting in a negative net zinc balance during the illness.

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