Green Banana Reduces Clinical Severity of Childhood Shigellosis
Green Banana Reduces Clinical Severity of Childhood Shigellosis
Background and Aims: Mature green banana (GB) fruit is rich in amylase-resistant starch that stimulates colonic production of short-chain fatty acids (referred to as fatty acid) and is useful in treating diarrheal diseases. We studied therapeutic effects of GB in childhood shigellosis by determining colonic fatty acid production in a double-blind, randomized, controlled, clinical trial.
Methods: Seventy-three children aged 6 to 60 months with severe bloody dysentery caused by Shigella infection were either given a rice-based diet (54 kcal/dL), with cooked GB (250 g/L) (n = 34) or without GB (n = 39) for 5 days; all given ciprofloxacin (15 mg/kg, q12 hours). Stool volume, frequency, excretion of blood/mucus, and relevant clinical and laboratory indices were determined.
Results: On day 5 (post-treatment), 59% children in GB group had no mucus compared with 36% in controls, fecal blood was completely cleared from 96% in GB group compared with 60% without GB (P < 0.05). GB treatment significantly reduced (P < 0.01) numbers of stools/day compared with controls (70% vs. 50%, P < 0.05). GB-specific reductions of mean fecal volumes (mL/kg) ranged from 25% to 40%; (P < 0.05) during the 5-day observations. Clinical success rates were 85% in GB group compared with 67% in controls (P < 0.05). GB significantly (P < 0.01) reduced fecal myeloperoxidase activity and increased fecal fatty acid concentrations (P < 0.01).
Conclusions: GB diet improves clinical severity in childhood shigellosis and could be a simple and useful adjunct for dietary management of this illness.
Despite advances in therapy and prevention, mortality due to shigellosis remains high specially among children in the third world countries. Although antibiotics and rehydration fluids are the mainstays of treatment, the effects of antibiotics may be compromised by the development of bacterial resistance to drugs, as well as its cost and availability. Thus, identification of effective, safe, and simple interventions (other than antibiotics) for the management of childhood shigellosis remains an important challenge. We have previously shown that unripe, green banana (GB), a common fruit added to regular diet of children enhances recovery from persistent diarrhea and improves intestinal mucosal integrity and nutrient absorption. These observations encouraged us to evaluate whether GB would be similarly useful in the treatment of acute childhood shigellosis for which no effective dietary management is available.
Unripe, mature fruit of green banana is rich in amylase-resistant starch which is not digested in human small intestine; these are fermented by colonic bacteria into short chain fatty acids (mostly acetate, propionate, butyrate), which are the major source of metabolic energy for the colonocytes. The observed antidiarrheal effects of GB are therefore related to its content of resistant starch and to the extent it is fermented to fatty acids by colonic microflora. Diets containing different types of resistant starch (inulin, oligofructose) and mixture of fatty acids have been shown to be clinically useful in patients with inflammatory bowel diseases that have pathogenic similarities to shigellosis. The beneficial effects of banana-supplemented feeds have been reported in critically ill patients and antidiarrheal effects of pectin, a fermentable source of resistant starch, were observed in man. GB has been reported to improve dyspepsia and peptic ulcer in man and to protect experimentally damaged intestinal mucosa in animals. Moreover, we observed that direct infusion of fatty acid solutions into Shigella-infected rabbit colon significantly improve severity of inflammation, enhance mucosal healing, and inhibit growth of Shigella organisms.
GB is grown and eaten in most developing countries in Asia, Africa, and Latin America; it is cheap, readily available, and is used as antidiarrheal by the folk healers in many communities. Our objectives were to evaluate the effects of GB in the management of childhood shigellosis by specifically examining the role of fatty acids as the mediator of GB-induced mucosal protection.
Abstract and Introduction
Abstract
Background and Aims: Mature green banana (GB) fruit is rich in amylase-resistant starch that stimulates colonic production of short-chain fatty acids (referred to as fatty acid) and is useful in treating diarrheal diseases. We studied therapeutic effects of GB in childhood shigellosis by determining colonic fatty acid production in a double-blind, randomized, controlled, clinical trial.
Methods: Seventy-three children aged 6 to 60 months with severe bloody dysentery caused by Shigella infection were either given a rice-based diet (54 kcal/dL), with cooked GB (250 g/L) (n = 34) or without GB (n = 39) for 5 days; all given ciprofloxacin (15 mg/kg, q12 hours). Stool volume, frequency, excretion of blood/mucus, and relevant clinical and laboratory indices were determined.
Results: On day 5 (post-treatment), 59% children in GB group had no mucus compared with 36% in controls, fecal blood was completely cleared from 96% in GB group compared with 60% without GB (P < 0.05). GB treatment significantly reduced (P < 0.01) numbers of stools/day compared with controls (70% vs. 50%, P < 0.05). GB-specific reductions of mean fecal volumes (mL/kg) ranged from 25% to 40%; (P < 0.05) during the 5-day observations. Clinical success rates were 85% in GB group compared with 67% in controls (P < 0.05). GB significantly (P < 0.01) reduced fecal myeloperoxidase activity and increased fecal fatty acid concentrations (P < 0.01).
Conclusions: GB diet improves clinical severity in childhood shigellosis and could be a simple and useful adjunct for dietary management of this illness.
Introduction
Despite advances in therapy and prevention, mortality due to shigellosis remains high specially among children in the third world countries. Although antibiotics and rehydration fluids are the mainstays of treatment, the effects of antibiotics may be compromised by the development of bacterial resistance to drugs, as well as its cost and availability. Thus, identification of effective, safe, and simple interventions (other than antibiotics) for the management of childhood shigellosis remains an important challenge. We have previously shown that unripe, green banana (GB), a common fruit added to regular diet of children enhances recovery from persistent diarrhea and improves intestinal mucosal integrity and nutrient absorption. These observations encouraged us to evaluate whether GB would be similarly useful in the treatment of acute childhood shigellosis for which no effective dietary management is available.
Unripe, mature fruit of green banana is rich in amylase-resistant starch which is not digested in human small intestine; these are fermented by colonic bacteria into short chain fatty acids (mostly acetate, propionate, butyrate), which are the major source of metabolic energy for the colonocytes. The observed antidiarrheal effects of GB are therefore related to its content of resistant starch and to the extent it is fermented to fatty acids by colonic microflora. Diets containing different types of resistant starch (inulin, oligofructose) and mixture of fatty acids have been shown to be clinically useful in patients with inflammatory bowel diseases that have pathogenic similarities to shigellosis. The beneficial effects of banana-supplemented feeds have been reported in critically ill patients and antidiarrheal effects of pectin, a fermentable source of resistant starch, were observed in man. GB has been reported to improve dyspepsia and peptic ulcer in man and to protect experimentally damaged intestinal mucosa in animals. Moreover, we observed that direct infusion of fatty acid solutions into Shigella-infected rabbit colon significantly improve severity of inflammation, enhance mucosal healing, and inhibit growth of Shigella organisms.
GB is grown and eaten in most developing countries in Asia, Africa, and Latin America; it is cheap, readily available, and is used as antidiarrheal by the folk healers in many communities. Our objectives were to evaluate the effects of GB in the management of childhood shigellosis by specifically examining the role of fatty acids as the mediator of GB-induced mucosal protection.
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