Gaffey Michelle F, Wazny Kerri, Bassani Diego G, Bhutta Zulfiqar A
BMC Public Health. 2013;13 Suppl 3(Suppl 3):S17. doi: 10.1186/1471-2458-13-S3-S17. Epub 2013 Sep 17.
Current WHO guidelines on the management and treatment of diarrhea in children strongly recommend continued feeding alongside the administration of oral rehydration solution and zinc therapy, but there remains some debate regarding the optimal diet or dietary ingredients for feeding children with diarrhea.
We conducted a systematic search for all published randomized controlled trials evaluating food-based interventions among children under five years old with diarrhea in low- and middle-income countries. We classified 29 eligible studies into one or more comparisons: reduced versus regular lactose liquid feeds, lactose-free versus lactose-containing liquid feeds, lactose-free liquid feeds versus lactose-containing mixed diets, and commercial/specialized ingredients versus home-available ingredients. We used all available outcome data to conduct random-effects meta-analyses to estimate the average effect of each intervention on diarrhea duration, stool output, weight gain and treatment failure risk for studies on acute and persistent diarrhea separately.
Evidence of low-to-moderate quality suggests that among children with acute diarrhea, diluting or fermenting lactose-containing liquid feeds does not affect any outcome when compared with an ordinary lactose-containing liquid feeds. In contrast, moderate quality evidence suggests that lactose-free liquid feeds reduce duration and the risk of treatment failure compared to lactose-containing liquid feeds in acute diarrhea. Only limited evidence of low quality was available to assess either of these two approaches in persistent diarrhea, or to assess lactose-free liquid feeds compared to lactose-containing mixed diets in either acute or persistent diarrhea. For commercially prepared or specialized ingredients compared to home-available ingredients, we found low-to-moderate quality evidence of no effect on any outcome in either acute or persistent diarrhea, though when we restricted these analyses to studies where both intervention and control diets were lactose-free, weight gain in children with acute diarrhea was shown to be greater among those fed with a home-available diet.
Among children in low- and middle-income countries, where the dual burden of diarrhea and malnutrition is greatest and where access to proprietary formulas and specialized ingredients is limited, the use of locally available age-appropriate foods should be promoted for the majority of acute diarrhea cases. Lactose intolerance is an important complication in some cases, but even among those children for whom lactose avoidance may be necessary, nutritionally complete diets comprised of locally available ingredients can be used at least as effectively as commercial preparations or specialized ingredients. These same conclusions may also apply to the dietary management of children with persistent diarrhea, but the evidence remains limited.
世界卫生组织当前关于儿童腹泻管理与治疗的指南强烈建议，在给予口服补液盐和锌治疗的同时应继续喂养，但对于腹泻儿童的最佳饮食或饮食成分仍存在一些争议。
我们系统检索了所有已发表的随机对照试验，这些试验评估了低收入和中等收入国家五岁以下腹泻儿童的基于食物的干预措施。我们将29项符合条件的研究分为一个或多个比较组：稀释的乳糖液体喂养与常规乳糖液体喂养、无乳糖液体喂养与含乳糖液体喂养、无乳糖液体喂养与含乳糖混合饮食，以及商业/特殊成分与家庭可用成分。我们使用所有可用的结局数据进行随机效应荟萃分析，以分别估计每项干预措施对急性腹泻和持续性腹泻研究中的腹泻持续时间、粪便排出量、体重增加和治疗失败风险的平均影响。
低至中等质量的证据表明，在急性腹泻儿童中，与普通含乳糖液体喂养相比，稀释或发酵含乳糖液体喂养不会影响任何结局。相比之下，中等质量的证据表明，在急性腹泻中，与含乳糖液体喂养相比，无乳糖液体喂养可缩短腹泻持续时间并降低治疗失败风险。在持续性腹泻中，仅有有限的低质量证据可用于评估这两种方法中的任何一种，或者在急性或持续性腹泻中评估无乳糖液体喂养与含乳糖混合饮食的比较。对于商业制备或特殊成分与家庭可用成分的比较，我们发现低至中等质量的证据表明，在急性或持续性腹泻中对任何结局均无影响，尽管当我们将这些分析限制在干预和对照饮食均为无乳糖的研究中时，发现急性腹泻儿童中食用家庭可用饮食的儿童体重增加更多。
在腹泻和营养不良双重负担最为严重且获得专利配方和特殊成分机会有限的低收入和中等收入国家，对于大多数急性腹泻病例，应推广使用当地可得的适龄食物。乳糖不耐受在某些情况下是一种重要的并发症，但即使在那些可能需要避免乳糖的儿童中，由当地可得成分组成的营养完整饮食至少可以与商业制剂或特殊成分一样有效。这些相同的结论也可能适用于持续性腹泻儿童的饮食管理，但证据仍然有限。
