Infectious diarrheal diseases and
protein-energy malnutrition (PEM) are major causes of child morbidity and mortality worldwide. In the present study, PEM was superimposed on
rotavirus infection in neonatal pigs to simulate chronic small intestinal stress in malnourished infants with viral
gastroenteritis. Two-day-old cesarean-derived pigs (n = 39) were allotted to three treatment groups: 1) noninfected, full-fed; 2) infected, full-fed; and 3) infected, malnourished. Two days postinfection, severe
diarrhea and
weight loss (11%) were accompanied by reductions in villus height (60%) and
lactase activity (78%) and increased crypt depth (32%) in infected full-fed compared with noninfected pigs (P < 0.05).
Malnutrition blunted (P < 0.05) increases in crypt depth elicited by rotavirus. By 9 d postinfection,
body weight was 59% less, villus height and
lactase activity remained lower (50%), and crypt depth remained greater (62%) in infected full-fed compared with noninfected pigs (P < 0.05). However,
diarrhea began to clear in infected full-fed, but not in infected malnourished pigs. Plasma
insulin-like growth factor-I (
IGF-I) was reduced 68% and crypt depth was reduced 19% in infected-malnourished compared with infected full-fed pigs (P < 0.05). Sixteen days postinfection, full-fed pigs had recovered from rotaviral
infection; however, in infected-malnourished pigs,
diarrhea and growth stasis persisted, and plasma
IGF-I, villus height and
alkaline phosphatase activity remained reduced compared with infected full-fed pigs (P < 0.05). Overall, PEM prolonged
diarrhea and delayed small-intestinal recovery, indicating that nutritional status during
diarrhea is essential for recovery from rotaviral
enteritis.