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I have just come across a research study in Xian where 201 hospitalized children with diarrhea and 53 children without diarrhea were checked for rotavirus, norovirus and adenovirus infection.

The results show that among the 201 children with diarrhea 68.7% (138/201) had a rotavirus infection, 20.4% (41/201) had a norovirus infection, and 5.0% (10/201) had an adenovirus infection. This is interesting, because it means that in the study group of children hospitalized with diarrhea, 94 % of them were infected by one of these three viruses!

For those 53 hospitalized children without diarrhea, the figures are slightly different: 13.2% (7/53) with rotavirus, 35.9% (19/53) with norovirus, and 9.4% (6/53) with adenovirus. Without more details in the abstract, it is difficult to interpret further, but we can certainly see that norovirus has a greater proportion of infection not leading to diarrhea. It may also remind us that these diseases are extremely contagious, including in hospital setting for children admitted for an other reason. That is a reason for trying not to hospitalize children with diarrhea, which in turn means a necessary focus on adequate home management of childhood diarrhea.

 

Nathanael Goldman, MD, MPH
May 2011

Introduction

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This essay is the result of observation in the consultation room that more and more children drink more milk for a prolonged period. At the same time, more children coming at the consultation for other reasons seem to have a tendency towards obesity from a very young age. While this may be multifactorial, children who are breastfed appear on averag smaller and thinner compared to children fed formula. On the other hand, reading from other scientific disciplines, in particular those pertaining to evolution and natural selection shed a new light on my approach of medicine. It told me that we are the products of an intimate coevolution between us and our environment, be it its physical properties, our relationships with other species (parasites in particular) and competition among our own kind. These interactions have slowly shaped us to function well in our overall stable environment. Changes in the environment put pressure on us towards a new, better adapted equilibrium with that environment. We then pay the price in terms of fitness (or health, having then an effect on our reproductive fitness, which in the end makes the difference at population level). Greater changes will push us towards greater needs for adaptation and take a higher toll on those of us with a genetic makeup less adapted to the new environment. If this tells me anything, it is that playing with our nutritional environment will put pressure on our health and for some more than others. Food (and the host of organisms living on our food in the gut) is indeed a very important part of our environment (certainly the greatest part, along with our lungs, in term of surface of exposure).

I believe that any hope of reversing the current alarming obesity epidemics will pass by a better understanding of early life mechanisms and the recognition that our kind is indistinguishably linked to the environment. I discuss here in this essay the historically (evolutionary) abnormal quantity, quality of milk, and duration that our children are to drink, encouraged sometimes by the medical profession and the industry. I set the hypothesis that this may have a deleterious health effect on some individuals and that it may have a role in promoting obesity. I then suggest a simple framework to minimize the risk of adverse health outcomes.
Before embarking on the discussion about milk and its role in feeding humans, there are several interesting points that can be mentioned, to help in the discussion and in its conclusions.