Document Type : Original articles

Authors

Department of Pediatrics, Al-Ramadi Maternity and Children Teaching Hospital, Anbar Health Directorate, Anbar, Iraq.

Abstract

Background: Secondary lactose intolerance occurs commonly from intestinal inflammation following infection recommending avoidance of milk contains lactose.
Objective: To identify the role of lactose-free milk (LFM) in the treatment of acute diarrhea in children ≤ 2 years in Al-Ramadi Maternity and Childhood Teaching Hospital in Ramadi city, Iraq.
Material and methods:  A single-blind randomized controlled trial study was done on babies ≤ two years old who presented with acute diarrhea. Two hundred cases were chosen randomly, 100 of them were received LFM added to the regime of management of diarrhea (group A), and the other 100 cases were received ordinary formula milk (OFM) (group B). Babies who were breastfeeding, those with chronic or bloody diarrhea, and those who received antibiotics were excluded from this study. Data about age, gender, the response ( stopping diarrhea), and its duration within 3 days were recorded.
Results: The response of stopping diarrhea after 3 days among group A was 89%, while group B was 67%. There was a highly statistically significant difference between the 2 groups (P-value = 0.001). Out of 44 babies in the age group 0-6 months in group A, there were 42 (95.4%) who respond to therapy, and it was the highest age group affected. There was a high statistically significant difference (P-value = 0.003) between the rate of response and the age group in group A. However, there was no significant difference (P-value > 0.05) between the gender and the response rate. Moreover, there was no significant difference (P-value >  0.05) between the rate of response and the age and gender of the babies in group B. There was a statistically significant difference (P-value<0.05) between group A and B concerning the mean duration of response (55.06 hours ± 11.304 in group A, and 63.58 hours ± 8.727 in group B).
Conclusion: There were a high response rate and rapid response among young children with acute diarrhea after giving LFM in comparison with OFM. 

Keywords

Main Subjects

[1]      W. Checkley et al., “Effects of nutritional status on diarrhea in Peruvian children,” J. Pediatr., vol. 140, no. 2, pp. 210–218, 2002.
[2]      S. Syed, A. Ali, and C. Duggan, “Environmental enteric dysfunction in children: a review,” J. Pediatr. Gastroenterol. Nutr., vol. 63, no. 1, p. 6, 2016.
[3]      B. U. K. Li et al., “North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome,” J. Pediatr. Gastroenterol. Nutr., vol. 47, no. 3, pp. 379–393, 2008.
[4]      P. H. Dennehy, “Acute diarrheal disease in children: epidemiology, prevention, and treatment,” Infect. Dis. Clin., vol. 19, no. 3, pp. 585–602, 2005.
[5]      A. N. Atia and A. L. Buchman, “Oral rehydration solutions in non-cholera diarrhea: a review,” Am. J. Gastroenterol., vol. 104, no. 10, pp. 2596–2604, 2009.
[6]      H. R. McCain, S. Kaliappan, and M. A. Drake, “Invited review: Sugar reduction in dairy products,” J. Dairy Sci., vol. 101, no. 10, pp. 8619–8640, 2018.
[7]      S. MacGillivray, T. Fahey, and W. McGuire, “Lactose avoidance for young children with acute diarrhoea,” Cochrane Database Syst. Rev., no. 10, 2013.
[8]      B. Grenov et al., “Undernourished children and milk lactose,” Food Nutr. Bull., vol. 37, no. 1, pp. 85–99, 2016.
[9]      M. B. Heyman, “Lactose intolerance in infants, children, and adolescents,” Pediatrics, vol. 118, no. 3, pp. 1279–1286, 2006.
[10]    G. Sethi, S. Sankaranarayanan, and M. Sukhija, “Low lactose in the nutritional management of diarrhea: Case reports from India,” Clin. Epidemiol. Glob. Heal., vol. 6, no. 4, pp. 160–162, 2018.
[11]    H. Szajewska and R. Shamir, Evidence-based research in pediatric nutrition. Karger Medical and Scientific Publishers, 2013.
[12]    J.-H. Xu and Y. Huang, “Efficiency of lactose-free formula feeding as an adjunctive therapy in infants with acute diarrhea,” Zhongguo dang dai er ke za zhi= Chinese J. Contemp. Pediatr., vol. 11, no. 7, pp. 532–536, 2009.
[13]    N. Simakachorn, Y. Tongpenyai, O. Tongtan, and W. Varavithya, “Randomized, double-blind clinical trial of a lactose-free and a lactose-containing formula in dietary management of acute childhood diarrhea,” JOURNAL-MEDICAL Assoc. Thail., vol. 87, no. 6, pp. 641–649, 2004.
[14]    S. Mehrabani, M. Esmaeili, L. Moslemi, and R. Tarahomi, “Effects of lactose-restricted regimen in breastfeeding children with acute diarrhea,” Int. J. Prev. Med., vol. 11, 2020.
[15]    E. R. A. L. Sadoon, L. F. AL-Juboori, and M. A. Ahmed, “Role of Lactose free milk in Acute Diarrhea.” Tikrit Journal of Pharmaceutical Sciences, vol. 7, no. 2, 2011.
[16]    M. Nabulsi, N. Yazbeck, and F. Charafeddine, “Lactose-free milk for infants with acute gastroenteritis in a developing country: study protocol for a randomized controlled trial,” Trials, vol. 16, no. 1, p. 46, 2015.
[17]    H. Saneian, O. Yaghini, M. Modaresi, and N. Razmkhah, “Lactose-free compared with lactose-containing formula in dietary management of acute childhood diarrhea,” Iran. J. Pediatr., vol. 22, no. 1, p. 82, 2012.
[18]    N. Dalgic, M. Sancar, B. Bayraktar, M. Pullu, and O. Hasim, “Probiotic, zinc and lactose‐free formula in children with rotavirus diarrhea: are they effective?,” Pediatr. Int., vol. 53, no. 5, pp. 677–682, 2011.
[19]    A. Guarino, S. Ashkenazi, D. Gendrel, A. Lo Vecchio, R. Shamir, and H. Szajewska, “European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014,” J. Pediatr. Gastroenterol. Nutr., vol. 59, no. 1, pp. 132–152, 2014.
[20]    W. H. Organization, Pocket book of hospital care for children: guidelines for the management of common childhood illnesses. World Health Organization, 2013.
[21]    S. Bhatnagar et al., “IAP Guidelines 2006 on management of acute diarrhea,” Indian Pediatr, vol. 44, no. 5, pp. 380–389, 2007.
[22]    R. A. Lapides and D. A. Savaiano, “Gender, age, race and lactose intolerance: is there evidence to support a differential symptom response? A scoping review,” Nutrients, vol. 10, no. 12, p. 1956, 2018.