Efficacy of lactose-free formula in acute diarrheal management for children under 5 years: a systematic review and meta-analysis
Abstract
Background Acute diarrhea is the most common gastrointestinal disease in children under five years of age with high morbidity and mortality risk. The use of lactose-free formula in the management of children with acute diarrhea was said to accelerate the diarrheal resolution time.
Objective To determine the efficacy of lactose-free formula in managing acute diarrhea in pediatric patients by systematic review and meta-analysis.
Methods A comprehensive literature search was conducted on PubMed, Proquest, Web of Science, and CINAHL Plus Database from November 1971 to July 11th, 2021. The study selection process was carried out under PRISMA 2020 guidelines based on several eligibility criteria. The quality of the included studies were further assessed using Modified Jadad Scores.
Results Fifteen randomized controlled trials (RCTs) were included, involving a total of 1,390 children with acute diarrhea. Shorter recovery time (MD -0.21; 95%CI -0.50 to 0.08; P=0.16) was observed in patients receiving lactose-free formula than the control group. However, this finding was not statistically significant. The subgroup analysis showed that lactose-free formula significantly shortened the recovery time compared to oral rehydration solution (ORS) group (MD -0.70; 95%CI -0.98 to -0.41; P=0.00001). Furthermore, lactose-free formula also significantly reduced the amount of stool output (MD -0.61; 95%CI -0.86 to -0.36; P=0.00001) and the incidence of persistent diarrhea more than seven days (OR 0.22; 95%CI 0.10 to 0.51; P=0.0004) compared to the control group.
Conclusion Lactose-free formula as dietary management for acute diarrhea in children can reduce stool output and the incidence of persistent diarrhea for more than seven days. It also may shorten the recovery time compared to the administration of ORS alone.
References
2. CDC. Disease Threats and Global WASH Killers: Cholera, Typhoid, and Other Waterborne Infections | Global Water, Sanitation and Hygiene | Healthy Water | CDC. Division of Foodborne, Waterborne, and Environmental Diseases at CDC. [cited 2021/08/12]. Available from: https://www.cdc.gov/healthywater/global/WASH.html (2017).
3. Saneian H, Yaghini O, Modaresi M, Razmkhah N.Lactose-free compared with lactose-containing formula in dietary management of acute childhood diarrhea. Iran. J. Pediatr. 22, 82–86 (2012). PMID: 23056864
4. Wall CR, Webster J, Quirk P, Robb TA, Cleghorn GJ, Davidson GP, et al. The nutritional management of acute diarrhea in young infants: effect of carbohydrate ingested. J. Pediatr. Gastroenterol. Nutr. 19, 170–174 (1994). DOI: https://doi.org/10.1097/00005176-199408000-00005
5. Simakachorn N, Tongpenyai Y, Tongtan O, Varavithya W.Randomized, double-blind clinical trial of a lactose-free and a lactose-containing formula in dietary management of acute childhood diarrhea. J. Med. Assoc. Thai. 87, 641–649 (2004). DOI: https://doi.org/10.1097/00005176-200406001-01252
6. Dalgic N, Sancar M, Bayraktar B, Pullu M, Hasim O. Probiotic, zinc and lactose-free formula in children with rotavirus diarrhea: Are they effective? Pediatr. Int. 53, 677–682 (2011). DOI: https://doi.org/10.1111/j.1442-200X.2011.03325.x
7. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. DOI: https://doi.org/10.1136/bmj.n71
8. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control. Clin. Trials. 1996;17:1–12. DOI: https://doi.org/10.1016/0197-2456(95)00134-4
9. Thorlund K, Imberger G, Johnston BC, Walsh M, Awad T, Thabane L, et al. Evolution of Heterogeneity (I2) Estimates and Their 95% Confidence Intervals in Large Meta-Analyses. PLoS One. 2012;7:e39471. DOI: https://doi.org/10.1371/journal.pone.0039471
10. Santosham, M. et al. Role of soy-based, lactose-free formula during treatment of acute diarrhea. Pediatrics. 1985;76:292–8 . PMID: 4022702
11. LIFSHITZ, F., NETO, U. F., OLIVO, C. A. G., CORDANO, A. & FRIEDMAN, S. Lifshitz F, Neto UF, Olivo CAG, Cordano A, Friedman S. Refeeding of infants with acute diarrheal disease. J. Pediatr. 1991;118:S99–S108. DOI: https://doi.org/10.1016/S0022-3476(05)81435-0
12. Torún, B. & Chew, F. Recent developments in the nutritional management of diarrhoea. 3. Practical approaches towards dietary management of acute diarrhoea in developing communities. Trans. R. Soc. Trop. Med. Hyg. 85, 12–17 (1991). DOI: https://doi.org/10.1016/0035-9203(91)90138-O
13. Kukuruzovic RH, Brewster DR.Milk formulas in acute gastroenteritis and malnutrition: a randomized trial. J. Paediatr. Child Health 38, 571–577 (2002). Paediatr. Child Health 38, 571–577 (2002). DOI: https://doi.org/10.1046/j.1440-1754.2002.00044.x
14. Mehrabani S, Esmaeili M, Moslemi L, Tarahomi R.Effects of lactose-restricted regimen in breastfeeding children with acute diarrhea. Int. J. Prev. Med. 11, 75 (2020). DOI: https://doi.org/10.4103/ijpvm.IJPVM_80_19
15. Lestari S, Firmansyah A, Munasir Z. Double blind clinical trial on a lactose-free and a lactose-containing formula in the treatment of acute diarrhea in children. Paediatr. Indones. 46, 271–275 (2006). DOI: https://doi.org/10.14238/pi46.6.2006.271-5
16. Allen UD, McLeod K, Wang EE. Cow’s milk versus soy-based formula in mild and moderate diarrhea: a randomized, controlled trial. Acta Paediatr. (Oslo, Norw. 1992) 83, 183–187 (1994). DOI: https://doi.org/10.1111/j.1651-2227.1994.tb13047.x
17. Haffejee IE.Cow’s milk-based formula, human milk, and soya feeds in acute infantile diarrhea: a therapeutic trial. J. Pediatr. Gastroenterol. Nutr. 10, 193–198 (1990). DOI: https://doi.org/10.1097/00005176-199002000-00009
18. McClean P, Lynch AB, Dodge JA. Comparison of three regimens in the management of acute gastroenteritis in infants. Aliment. Pharmacol. Ther. 4, 457–464 (1990). DOI: https://doi.org/10.1111/j.1365-2036.1990.tb00492.x
19. Noreen A, Jalal A, Qudsia, Jabeen R, Qamar S. Comparison of Lactose Free With Lactose Containing Formula Milk in the Management of Acute Watery Diarrhoea in Infants. PAKISTAN J. Med. Heal. Sci. 10, 1337–1339 (2016).
20. Bhan MK, Arora NK, Khoshoo V, Raj P, Bhatnager S, Sazawal S, et al. Comparison of a lactose-free cereal-based formula and cow’s milk in infants and children with acute gastroenteritis. J. Pediatr. Gastroenterol. Nutr. 1988;7:208–13. DOI: https://doi.org/10.1097/00005176-198803000-00009
21. Nezhadian A, Ahmadi M, Assar S. Determining the effect of lactose-free formula on the improvement of acute diarrhea among infants aged 3 to 24 months. J Complement Med Res. 2020;11:215-22.
22. Vanga SK, Raghavan V.How well do plant based alternatives fare nutritionally compared to cow’s milk? J. Food Sci. Technol. 2018;55:10–20. DOI: https://doi.org/10.1007/s13197-017-2915-y
23. Vernacchio L, Vezina RM, Mitchell AA, Lesko SM, Plaut AG, Acheson DWK.Characteristics of persistent diarrhea in a community-based cohort of young US children. J. Pediatr. Gastroenterol. Nutr. 2006;43:52–8. DOI: https://doi.org/10.1097/01.mpg.0000228094.74207.39
24. Antonietta G, Guarino A, Lo VA. Management of children with prolonged diarrhea. F1000Res. 2016;5:F1000 Faculty Rev-206. DOI: https://doi.org/10.12688/f1000research.7469.1
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Accepted 2024-05-30
Published 2024-05-30
