Lactose avoidance reduces duration of diarrhea and risk of treatment failure in young children

Background

Acute diarrhea is the most common illness experienced by young children globally. During diarrhea intestinal inflammation or injury can occur which may temporarily stop the production of lactose digesting intestinal enzyme lactase. Inability to digest lactose may worsen or prolong the illness. Avoiding lactose containing products during diarrheal episode reduces the duration and severity of diarrhea.

Aim

To assess if lactose-free feed shortens the duration and severity of diarrhea.

Study Design

A randomized controlled trial consisting of 2973 children less than 5 years of age with acute diarrhea. 22 trials comparing lactose-free and lactose-containing intervention and 11 trials comparing diluted lactose and undiluted lactose feed.

Types of interventions:

1. Lactose‐free versus lactose‐containing (at least 2%) feed
2. Diluted (by at least 50%) versus undiluted lactose‐containing feed

Primary outcome

1. Duration of diarrhoea, defined as time to first normal stool (when subsequent stools were normal for a 24‐hour period)

Secondary outcome

1. Treatment failure (discontinuation of the intervention or withdrawal from the trial or change in nutritional management due to worsening diarrhoea or vomiting)
2. Duration of hospital stay
3. Stool volume
4. Change in body weight

Results and Discussions

• Lactose‐free versus lactose‐containing (at least 2%) feed

Primary outcome

1. Duration of diarrhoea: Lactose free feed reduced the duration of diarrhea significantly by 18 hours compared to lactose containing feed.

Secondary outcome

1. Treatment failure: Lactose free feed was associated with reduced risk of treatment failure by 50%.
2. There was no statistical difference in the number of days spent in hospital, stool volume and change in body weight were observed among the groups.

• Diluted versus undiluted lactose‐containing feed

1. No statistical differences in duration of diarrhea, stool volume and change in body weight were observed among the groups. Suggesting that diluted lactose or reduced lactose feed do not have any benefit for treatment of diarrhea.
2. Treatment failure: Diluted milk reduced the risk of treatment failure by a third.

Conclusion:

Lactose free milk feed reduces the duration of diarrhea and the risk of treatment failure. Suggesting that young children with acute diarrhea may benefit with a lactose-free feed.

Reference

1. Stephen MacGillivray, et.al. Lactose avoidance for young children with acute diarrhoea. Cochrane Database Syst Rev. 2013 Oct; 2013(10): CD005433. Published online 2013 Oct 31.