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

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

To assess if avoiding or reducing intake of lactose-containing milk or milk products shortens the duration and severity of illness in young children with acute diarrhea'. We also sought other indicators of morbidity and overall mortality.

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 the lactose-digesting intestinal enzyme lactase. inability to digest lactose may worsen or prolong the illness. Avoiding lactose-containing products during diarrheal episodes 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 compared lactose-free and lactose-containing interventions, and 11 trials compared 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 diarrheas', 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, withdrawal from the trial or change in nutritional management due to worsening diarrheas' 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 diarrheas': 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 a reduced risk of treatment failure by 50%.
2. There was no statistical difference in the number of days spent in the hospital, stool volume, or change in body weight observed among the groups.

• Diluted versus undiluted lactose-containing feed

1. No statistical differences in duration of diarrhea, stool volume, or change in body weight were observed among the groups. Suggesting that diluted lactose or reduced lactose feed do not have any benefit for the 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 from a lactose-free feed.

Reference

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