Milk formulas in acute gastroenteritis and malnutrition: a randomized trial

Area of Science:

• Pediatric Gastroenterology
• Nutritional Science
• Tropical Medicine

Background:

• High prevalence of lactose intolerance, osmotic diarrhea, and environmental enteropathy in Aboriginal children.
• Need for effective nutritional interventions for diarrhea and malnutrition in this population.

Purpose of the Study:

• To compare three low-lactose milk formulas with varying osmolality and protein hydrolysis for treating diarrhea and malnutrition.
• To assess the impact of these formulas on diarrheal severity, weight gain, palatability, and intestinal permeability.

Main Methods:

• Randomized double-blind trial involving 180 Aboriginal children under 3 years old.
• Intervention formulas: De-Lact (low-osmolality, lactose-free), O-Lac (lactose-free), and Alfaré (partially hydrolyzed).
• Outcome measures included diarrheal duration, weight gain, palatability, and intestinal permeability (L/R ratios).

Main Results:

• Diarrhea duration was significantly longer with Alfaré compared to De-Lact and O-Lac (P=0.04).
• Alfaré had significantly worse palatability (P<0.01).
• De-Lact showed significantly greater improvement in intestinal permeability (P=0.05). Malnourished subgroup showed better weight gain on De-Lact.

Conclusions:

• Low-osmolality milk (De-Lact) was associated with better outcomes in Aboriginal children with diarrhea and growth failure.
• Partially hydrolyzed formula (Alfaré) showed less improvement in mucosal recovery.
• Cow's milk protein intolerance may not be a primary driver of severe diarrhea or enteropathy in this population.