Is dilution of cows' milk formula necessary for dietary management of acute diarrhoea in infants aged less than 6 months?

Chew, Francisco; Chen, Quan; Filho, Luiz Alexandre; Lopes, Maria Claudia da Silva Oliveira; Mota, Jaciane; Penna, Francisco José; Fontaine, Olivier

doi:10.1016/0140-6736(93)90063-m

Cited by 42 publications

(14 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(1) The infants in our trial were older than in most previous studies (77% of infants were more than 6 months old at enrolment); most diarrhoea treatment failures occur in younger infants because of age related factors, such as IgA deficiency and a relative pancreatic insufficiency 15. (2) None of our patients was malnourished; treatment failures are more common in malnourished infants,16 probably because of the destruction of intestinal villi and diminished lactase activity 17. (3) In comparison with other studies the infants in this trial had a shorter duration of diarrhoea before admission 18.…”

Section: Discussionmentioning

confidence: 88%

Randomised trial of different rates of feeding in acute diarrhoea

Wan

Phillips

Dibley

et al. 1999

Archives of Disease in Childhood

View full text Add to dashboard Cite

Objective-To compare the eVect of different feeding frequencies on the speed of recovery from diarrhoea. Methods-A randomised, non-blinded trial provided 0.452 MJ/kg/day as either 6 or 12 feeds of cows' milk each day to 262 hospitalised male infants aged 3-12 months with acute diarrhoea. Stool frequency, stool weight, body weight, and diarrhoea complications were monitored until recovery or for 14 days. Results-A proportional hazards regression model controlling for age, diarrhoea aetiology, and severity of dehydration on admission revealed that the frequently fed group had a significantly shorter duration of diarrhoea (hazards ratio, 1.29; 95% confidence interval, 1.002 to 1.653). Frequently fed infants had a significantly greater weight gain and significantly lower faecal frequency and faecal weight. Conclusions-Breast feeding remains the preferred method of feeding infants with acute diarrhoea, but feeding cows' milk to adequately nourished infants with acute diarrhoea is safe and is more rapidly eVective if provided in frequent feeds with low energy loads. (Arch Dis Child 1999;81:487-491)

show abstract

Section: Discussionmentioning

confidence: 88%

Randomised trial of different rates of feeding in acute diarrhoea

Wan

Phillips

Dibley

et al. 1999

Archives of Disease in Childhood

View full text Add to dashboard Cite

show abstract

“…Five studies [22-26] compared diluted to undiluted milk products, and three studies [27-29] compared acidified or fermented milk products to regular milk products. One study allowed non-milk complementary foods in addition to the intervention and control liquid feeds, with both comparison groups receiving the identical complementary foods [27].…”

Section: Resultsmentioning

confidence: 99%

“…The pooled results from four studies reporting on diarrhea duration [22,25,26,29], three studies reporting on stool output [22,26,28], two studies reporting on weight change [22,26] and six studies reporting on treatment failure [22-27] showed no statistically significant effects of reduced lactose liquid feeds on any outcome (Table 2). The overall quality of evidence was assessed as low for the outcome of duration and moderate for the stool output, weight change and treatment failure outcomes.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2013

View full text Add to dashboard Cite

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.

show abstract

“…Only 6% of the children were put on a milk-free diet. Many studies suggest that milk products do not prolong the course of a diarrhoeal episode (14,(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

Community-based survey of paediatric diarrhoeal morbidity and home treatment practices in Finland

Rautanen¹,

Halme

Vesikari

1998

SPAE

View full text Add to dashboard Cite

To determine total diarrhoeal morbidity and current home case management practices, a recall study was conducted among 345 mothers whose 406 children under 5 y of age had had diarrhoea in the past 4 months. The seasonally adjusted annual diarrhoea incidence rate was 0.48 episodes/child/y. For home treatment, increased amounts of fluid were given in 93% and oral rehydration solution (ORS) in 37% of cases. However, when given, ORS was diluted with other fluids in 41% of cases. More than half (55%) of the children received increased or normal amounts of food during the diarrhoeal episode, but 7% of the children were kept fasting for at least 1 d. Use of antidiarrhoeal drugs was minimal (0.7%), but products containing lactic acid bacteria were given in 44% of cases. Case management practice in cases of diarrhoea at home have much improved during the last 20 y, but are still not optimal.

show abstract

Is dilution of cows' milk formula necessary for dietary management of acute diarrhoea in infants aged less than 6 months?

Cited by 42 publications

References 15 publications

Randomised trial of different rates of feeding in acute diarrhoea

Randomised trial of different rates of feeding in acute diarrhoea

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

Community-based survey of paediatric diarrhoeal morbidity and home treatment practices in Finland

Contact Info

Product

Resources

About