Clinical Trial of Modified Whole Milk, Lactose-Hydrolyzed Whole Milk, or Cereal-Milk Mixtures for the Dietary Management of Acute Childhood Diarrhea

Brown, Kenneth H.; Pérez, Fernando Pereira; Gastañaduy, Arturo S.

doi:10.1097/00005176-199104000-00010

Cited by 38 publications

(25 citation statements)

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“…The dramatic differences in the duration of liquid stool excretion are consistent with previous comparisons of mixed diets and synthetic formulas (20,21,25). We have recently found similar differences in the duration of liquid stool excretion in relation to dietary fiber content when an unsupplemented lactose-free formula was compared with the same formula to which fiber had been added (26).…”

Section: Discussionsupporting

confidence: 89%

Evaluation of a maize‐cowpea‐palm oil diet for the dietary management of Nigerian children with acute, watery diarrhea

Grange¹,

Santosham²,

Ayodele³

et al. 1994

Acta Paediatrica

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A randomized clinical trial was carried out to compare a locally available maize-cowpea-palm oil diet (group MCP) with a commercially produced lactose-free, soy protein isolate formula (group SF) for the dietary management of 69 Nigerian boys, 6-24 months of age, hospitalized for acute, watery diarrhea. Although the treatment groups were generally similar initially, the children in group SF had slightly lower mean weight-for-age z scores (p = 0.08), lower serum bicarbonate levels (p = 0.04) and greater stool outputs during the period of rehydration before the diets were initiated (p = 0.01). Rates of treatment failure in group MCP (5.7%) and group SF (8.8%) were similar (p = 0.67). There were no significant differences in the adjusted mean stool outputs by study group on days 1-5, but the children in group SF had slightly lower fecal weights on day 6 (p = 0.05). Children in group MCP had a substantially reduced duration of liquid stool excretion (estimated median duration 42 h versus 140 h; p < 0.001). On the other hand, children in group SF consumed considerably more of their diet, had greater net absorption of macronutrients and greater rates of weight gain than those in group MCP. We conclude that children can safely consume the MCP diet during acute, watery diarrhea without increasing their risk of treatment failure or augmenting stool output. However, the diet may not be adequate as a sole source of nutrients beyond the period of acute illness.

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Section: Discussionsupporting

confidence: 89%

Evaluation of a maize‐cowpea‐palm oil diet for the dietary management of Nigerian children with acute, watery diarrhea

Grange¹,

Santosham²,

Ayodele³

et al. 1994

Acta Paediatrica

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“…5 Recent evidence in the literature suggests that unrestricted diets do not worsen the course of mild diarrhea, 8 -10 may reduce stool output, 11 are usually well tolerated, 7,10 and do not necessitate the avoidance of lactose. 6,9,10,12 Therefore, the recent recommendations call for continuation of age-appropriate diets in children without dehydration and reintroduction of ageappropriate diets in dehydrated children as soon as they are rehydrated. 2 The aim of the present study was to examine the knowledge and practice of the revised AAP guidelines of 1996 among pediatricians in Israel, the effect of medical school (Israeli vs foreign medical school graduates), and the type of practice (community vs hospital) in the management of GE.…”

mentioning

confidence: 99%

Management of Acute Gastroenteritis in Children in Israel

Shamir

Zahavi²,

Abramowich³

et al. 1998

Pediatrics

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“…Six studies compared cow’s milk or cow’s milk-based formula with soy-based, casein-based or whey-based formulas [16,23,31-34], one study compared regular milk to milk in which at least 95% of the lactose had been hydrolyzed [35], and one study compared soy-based formulas with and without added lactose [36]. Three studies allowed non-milk complementary foods in addition to the intervention and control liquid feeds, with complementary foods given identically across comparison groups [16,32,36].…”

Section: Resultsmentioning

confidence: 99%

“…The pooled result from five studies [16,31,32,35,36] showed a statistically significant effect of lactose-free liquid feeds on reducing diarrhea duration (SMD: -0.36; 95%CI: -0.62 to -0.10; p=0.008) (Table 3). Effect sizes and their statistical significance varied across studies but were consistent in direction (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

“…Effect sizes and their statistical significance varied across studies but were consistent in direction (Figure 2). No effect of lactose-free liquid feeds was shown in the pooled results from three studies on stool output [16,34,35] or from three studies on weight change [16,35,36], but the evidence from seven studies [16,23,32-36] showed a statistically significant reduction of 47% in the risk of treatment failure (RR: 0.53; 95%CI: 0.40 to 0.70; p<0.0001). Effect sizes and their statistical significance varied across studies but were consistent in direction with the exception of one study (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

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Dietary management of childhood diarrhea in low- and middle-income countries: a systematic review

et al. 2013

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BackgroundCurrent WHO guidelines on the management and treatment of diarrhea in children strongly recommend continued feeding alongside the administration of oral rehydration solution and zinc therapy, but there remains some debate regarding the optimal diet or dietary ingredients for feeding children with diarrhea.MethodsWe conducted a systematic search for all published randomized controlled trials evaluating food-based interventions among children under five years old with diarrhea in low- and middle-income countries. We classified 29 eligible studies into one or more comparisons: reduced versus regular lactose liquid feeds, lactose-free versus lactose-containing liquid feeds, lactose-free liquid feeds versus lactose-containing mixed diets, and commercial/specialized ingredients versus home-available ingredients. We used all available outcome data to conduct random-effects meta-analyses to estimate the average effect of each intervention on diarrhea duration, stool output, weight gain and treatment failure risk for studies on acute and persistent diarrhea separately.ResultsEvidence of low-to-moderate quality suggests that among children with acute diarrhea, diluting or fermenting lactose-containing liquid feeds does not affect any outcome when compared with an ordinary lactose-containing liquid feeds. In contrast, moderate quality evidence suggests that lactose-free liquid feeds reduce duration and the risk of treatment failure compared to lactose-containing liquid feeds in acute diarrhea. Only limited evidence of low quality was available to assess either of these two approaches in persistent diarrhea, or to assess lactose-free liquid feeds compared to lactose-containing mixed diets in either acute or persistent diarrhea. For commercially prepared or specialized ingredients compared to home-available ingredients, we found low-to-moderate quality evidence of no effect on any outcome in either acute or persistent diarrhea, though when we restricted these analyses to studies where both intervention and control diets were lactose-free, weight gain in children with acute diarrhea was shown to be greater among those fed with a home-available diet.ConclusionsAmong children in low- and middle-income countries, where the dual burden of diarrhea and malnutrition is greatest and where access to proprietary formulas and specialized ingredients is limited, the use of locally available age-appropriate foods should be promoted for the majority of acute diarrhea cases. Lactose intolerance is an important complication in some cases, but even among those children for whom lactose avoidance may be necessary, nutritionally complete diets comprised of locally available ingredients can be used at least as effectively as commercial preparations or specialized ingredients. These same conclusions may also apply to the dietary management of children with persistent diarrhea, but the evidence remains limited.

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Clinical Trial of Modified Whole Milk, Lactose-Hydrolyzed Whole Milk, or Cereal-Milk Mixtures for the Dietary Management of Acute Childhood Diarrhea

Cited by 38 publications

References 0 publications

Evaluation of a maize‐cowpea‐palm oil diet for the dietary management of Nigerian children with acute, watery diarrhea

Evaluation of a maize‐cowpea‐palm oil diet for the dietary management of Nigerian children with acute, watery diarrhea

Management of Acute Gastroenteritis in Children in Israel

Dietary management of childhood diarrhea in low- and middle-income countries: a systematic review

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