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

Abstract

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.

Validation of primer for promoting maternal self-efficacy in preventing childhood diarrhea

“…Regarding the care related to diarrhea in children who are in exclusive breastfeeding, new information was added based on the script of the educational video, proposed in previous research (15) . Thus, we advise to the mother to keep breastfeeding and, in addition, to offer to the child oral rehydration solution only, since it is consensus that breastfeeding must be maintained during episodes of diarrhea (25) .…”

Nutritional Management in Child Diarrhea: An Evaluation of Awareness in General Population from Dobrogea Region

“…Foods like rice (chosen by 70%), toast (67.27%), applesauce/ baked apple (50.90%), mint/figs/bilberry leaves teas (43.63%), vegetables soup (43.63%), and bananas (40.90%), grilled/boiled meat like chicken breast or beef (40.90%), boiled carrots (40%) were in top of preferences of people. All these represents proper choices (7,14,15). Figure 1 shows foods in the order of people preferences for adding them in children's diet.…”

“…Special attention must be paid on the foods used: the quantity and quality of their nutrients, the quality of the carbohydrates and fats, biological values of the proteins and, if possible, their osmolarity. The need of specific foods must be considered as well (6,7).…”

Dietary Factors in Prevention of PediatricEscherichia coliInfection: A Model Using Domestic Piglets

“…Accumulating evidence has confirmed the importance of nutritional interventions, including modified feeding strategies and nutrient supplements, in the control of diarrheal diseases and prevention of enteric infection (Table 1). 84,85 For example, probiotics are probably the most popular supplements recommended to be used to treat or prevent infant diarrhea. [86][87][88][89] Supplementation with micronutrients, such as zinc, also showed a protective effect in both well-nourished and malnourished children with diarrhea.…”