Nutritional intervention in acute diarrhea: is a lactose-free formula essential?

A prospective study was done to determine the incidence of disaccharide intolerance among 3-36 month-old patients with acute watery diarrhea who were on breast feeding and/or lactose-containing formula. The effect of feeding intervention on the outcome was investigated. Significant disaccharide intolerance was defined as one with (1) biochemical derangements: stool pH < 6.0 (Riedel de Haen pH paper) and reducing substances > or = 0.5 mg% (Clinitest) on two consecutive determinations and (2) clinical evidence: high purging rate (> 10 gm/kg/hour) and reappearance of dehydration and/or weight loss while on a lactose containing milk. Seven of 92 patients (7.8%) had biochemical evidence of disaccharide malabsorption on admission. Subsequent monitoring of the study population showed absence of disaccharide intolerance. Despite a lactose containing formula, a significant (p < 0.05) reduction in stool output from the first to the second day (145.85 +/- 130.26 vs 115.43 +/- 95.65 g/kg admission weight) was noted. Likewise, weight gain from admission to discharge (4.56 +/- 3.44%) was observed. The mean total duration of illness (4.75 +/- 2.84 days) was well within the usual course of five to seven days. This study supports the current recommendation of continued breast feeding and/or use of lactose containing formula during acute watery diarrhea.