Expert recommendations on feeding practices of milk diets in acute infant diarrhea in India: a collaborative position statement Expert opinion on nutritional management in acute infant diarrhea
Main Article Content
Abstract
Acute infant diarrhea has a significant impact on India's public health landscape, which is characterized by regional disparities and predominantly viral causes that often resolve on their own. The primary management objective of acute infant diarrhea is to ensure quick recovery while maintaining the nutritional intake of affected infants, aiming to reduce weight loss, manage loose stools better, and reduce the duration of diarrhea. Early refeeding, oral rehydration solution (ORS), and zinc supplementation are critical strategies, according to international consensus and scientific validation. Milk-based diets practically form a key part of dietary choices in young children. There was a need to develop an expert position for the nutritional management of acute infant diarrhea in this aspect in the Indian context. Therefore, between July and September 2023, a series of expert meetings across India were dedicated to formulating an evidence-based position for the nutritional management of acute infant diarrhea. The emphasis was on the benefits of continuing feeding and early refeeding as appropriate, and promoting continued breastfeeding. For non-breastfed infants, a strategic approach to selecting suitable milk diets was deliberated, supporting rapid recovery without compromising nutrition. This strategy not only supports the overall developmental well-being of the infant but also addresses potential issues related to alternative diets, such as palatability, potential long-term effects, and the challenges of reverting to standard milk diets. Through these discussions, a comprehensive framework for managing nutrition in acute diarrhea in infants with milk-based diets was established, highlighting the importance of continued nutritional intake along with standard management guidelines.
Keywords:
Diarrhea, infant, low lactose, weight loss, early refeeding, secondary lactose intolerance, malnutrition
Article Details
How to Cite
CONSORTIUM, Gut Health et al.
Expert recommendations on feeding practices of milk diets in acute infant diarrhea in India: a collaborative position statement.
Medical Research Archives, [S.l.], v. 12, n. 9, oct. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5677>. Date accessed: 26 oct. 2024.
doi: https://doi.org/10.18103/mra.v12i9.5677.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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38. 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 (1994) 19:170-4. doi: 10.1097/00005176-199408000-00005
39. Guarino A, Vecchio AL, Dias JA, Berkley JA, Boey C, Bruzzese D, et al. Universal recommendations for the management of acute diarrhea in nonmalnourished children. J Pediatr Gastroenterol Nutr (2018) 67:586–93. doi: 10.1097/MPG.0000000000002053
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41. American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis. Practice parameter: The management of acute gastroenteritis in young children. Pediatrics (1996) 97:424–35.
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45. Wardlaw T, Salama P, Brocklehurst C, Chopra M, Mason E. Diarrhoea: Why children are still dying and what can be done. Lancet (2010) 375:870–2. doi: 10.1016/S0140-6736(09)61798-0.
2. UNICEF. The United Nations International Children’s Emergency Fund 2019 Report on Diarrhoea. https://data.unicef.org/topic/child-health/diarrhoeal-disease/ [Accessed October 7, 2023].
3. International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005–06: India: Volume I (2007). https://dhsprogram.com/pubs/pdf/frind3/frind3-vol1andvol2.pdf [Accessed September 29, 2023].
4. International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), 2015–16: India (2017). http://rchiips.org/nfhs/NFHS-4Reports/India.pdf [Accessed September 29, 2023].
5. National Family Health Survey (NFHS-5), 2019–21: India Fact Sheet. https://main.mohfw.gov.in/sites/default/files/NFHS-5_Phase-II_0.pdf [Accessed September 29,2023].
6. Roy SK, Buis M, Weersma R, Khatun W, Chowdhury S, Begum A, et al. Risk factors of mortality in severely-malnourished children hospitalized with diarrhoea. J Health Popul Nutr (2011) 29:229–35. doi:10.3329/jhpn.v29i3.7870
7. Chiabi A, Obadeyi B, Nguefack F, Chiabi R, Berinyuy E, Chiabi E, et al. The vicious cycle of malnutrition and childhood infections – What are the policy implications? Arch Pediatr Neonatol (2018) 1:21–5. doi: 10.22259/2638-5155.0101006
8. Subramani H, Patil R, Nisha N, Palve S, A L. A study of misconceptions about childhood diarrhoea among adults in urban Pondicherry, India. Int J Community Med Public Health (2016) 3:1442–48. doi: 10.18203/2394-6040.ijcmph20161608
9. Gandra NR, Farooqui D. Diarrhoea, nutrition and oral rehydration therapy: Awareness, attitude and practices among mothers of children under five years. Int J Contemp Pediatr (2017) 4:1995–2001. doi: 10.18203/2349-3291.ijcp20174182
10. Padhy S, Sethi RK, Behera N. Mother’s knowledge, attitude and practice regarding prevention and management of diarrhoea in children in Southern Odisha. Int J Contemp Pediatr (2017) 4:966-71. doi: 10.18203/2349-3291.ijcp20171708
11. Nemeth V, Pfleghaar N. Diarrhea. In: StatPearls. Treasure Island (FL): StatPearls Publishing (2023). http://www.ncbi.nlm.nih.gov/books/NBK448082/
12. Menon VK, George S, Sarkar R, Giri S, Samuel P, Vivek R, et al. Norovirus Gastroenteritis in a Birth Cohort in Southern India. PLoS One (2016) 11:e0157007. doi: 10.1371/journal.pone.0157007
13. Acharyya BC, Srivastava PK. Nutritional management during and beyond diarrhea. Role of rice-based foods. Neonat Pediatr Med (2022) 8:263. doi: 10.4172/2572-4983.1000263
14. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. 2nd ed. Geneva: World Health Organization (2013). http://www.ncbi.nlm.nih.gov/books/NBK154447/
15. Heine RG, AlRefaee F, Bachina P, De Leon JC, Geng L, Gong S, et al. Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited. World Allergy Organ J (2017) 10:41. doi: 10.1186/s40413-017-0173-0
16. Veerlapati R, Prasad KNV. Study on lactose intolerance in children with acute diarrhoea. JMSCR (2019) 7:502-508. doi: 10.18535/jmscr/v7i10.85
17. McClean P, Lynch AB, Dodge JA. Comparison of three regimens in the management of acute gastroenteritis in infants. Aliment Pharmacol Ther (1990) 4:457–464. doi: 10.1111/j.1365-2036.1990.tb00492.x.
18. Huppertz HI, Forster J, Heininger U, Roos R, Neumann HU, Hammerschmidt T. The Parental Appraisal of the Morbidity of Diarrhea in Infants and Toddlers (PAMODI) survey. Clin Pediatr (2008) 47:363–71. doi: 10.1177/0009922807310933
19. Dekate P, Jayashree M, Singhi SC. Management of acute diarrhea in emergency room. Indian J Pediatr (2013) 80:235–246. doi: 10.1007/s12098-012-0909-3
20. Brown KH. Diarrhea and malnutrition. J Nutr (2003) 133:328S–332S. doi:10.1093/jn/133.1 .328S
21. Talbert A, Thuo N, Karisa J, Chesaro C, Ohuma E, Ignas J, et al. Diarrhoea complicating severe acute malnutrition in Kenyan children: A prospective descriptive study of risk factors and outcome. PLoS One (2012) 7:e38321. doi: 10.1371/journal.pone.0038321
22. Viegelmann GC, Dorji J, Guo X, Lim HY. Approach to diarrhoeal disorders in children. Singapore Med J (2021) 62:623–9. doi: 10.11622/smedj.2021234
23. Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H, et al. 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 (2014) 59:132–52. doi: 10.1097/MPG.0000000000000375
24. Leung A, Prince T, Canadian Paediatric Society, Nutrition and Gastroenterology Committee. Oral rehydration therapy and early refeeding in the management of childhood gastroenteritis. Paediatr Child Health (2006) 11:527–31. doi: 10.1093/pch/11.8.527
25. Sandhu BK, Isolauri E, Walker-Smith JA, Banchini G, Van Caillie-Bertrand M, Dias JA, et al. A multicentre study on behalf of the European Society of Paediatric Gastroenterology and Nutrition Working Group on acute diarrhoea. Early feeding in Childhood Gastroenteritis. J Pediatr Gastroenterol Nutr (1997) 24:522–7. doi: 10.1097/00005176-199705000-00006
26. Manary M, Iannotti L, Trehan I, Weisz A. Systematic review of the care of children with diarrhoea in the community-based management of severe acute malnutrition. In Geneva: World Health Organization; 2012.
27. Bhutta ZA, Black RE, Brown KH, Gardner JM, Gore S, Hidayat A, et al. Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: Pooled analysis of randomized controlled trials. Zinc Investigators’ Collaborative Group. J Pediatr (1999) 135:689–697. doi: 10.1016/s0022-3476(99)70086-7
28. Grenov B, Briend A, Sangild PT, Thymann T, Rytter MH, Hother AL, et al. Undernourished children and milk lactose. Food Nutr Bull (2016) 37:85–99.doi: 10.1177/0379572116629024
29. Sethi G, Sankaranarayanan S, Sukhija M. Low lactose in the nutritional management of diarrhea: Case reports from India. Clin Epidemiol Glob Health (2018) 6:160–162. doi: 10.1016/j.cegh.2018.02.002
30. Conway SP, Ireson A. Acute gastroenteritis in well-nourished infants: Comparison of four feeding regimens. Arch Dis Child (1989) 64:87–91. doi: 10.1136/adc.64.1.87
31. Romero-Velarde E, Delgado-Franco D, García-Gutiérrez M, Gurrola-Díaz C, Larrosa-Haro A, Montijo-Barrios E, et al. The importance of lactose in the human diet: Outcomes of a Mexican consensus meeting. Nutrients (2019) 11:2737. doi: 10.3390/nu11112737
32. Schaafsma G. Lactose and lactose derivatives as bioactive ingredients in human nutrition. Int Dairy J (2008) 18:458–65. doi: 10.1016/j.idairyj.2007.11.013
33.Alam S, Khanna R, Firdaus U. Acute childhood diarrhea: A review of recent advances in the standard management. Pediatr Oncall J (2006) 3:72.
34. Canadian Paediatric Society. Concerns for the use of soy-based formulas in infant nutrition. Paediatr Child Health (2009) 14:109–113.
35. Jabbar MA, Larrea J, Shaw RA. Abnormal thyroid function tests in infants with congenital hypothyroidism: the influence of soy-based formula. J Am Coll Nutr (1997) 16:280–282. doi: 10.1080/07315724.1997.10718686
36. Vega RM, Avva U. Pediatric Dehydration. In: StatPearls. Treasure Island (FL): StatPearls Publishing (2023). http://www.ncbi.nlm.nih.gov/books/NBK436022/
37. Ashraf H, Ahmed S, Fuchs GJ, Mahalanabis D. Persistent diarrhoea: Associated infection and response to a low lactose diet. J Trop Pediatr (2002) 48:142–148. doi: 10.1093/tropej/48.3.142
38. 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 (1994) 19:170-4. doi: 10.1097/00005176-199408000-00005
39. Guarino A, Vecchio AL, Dias JA, Berkley JA, Boey C, Bruzzese D, et al. Universal recommendations for the management of acute diarrhea in nonmalnourished children. J Pediatr Gastroenterol Nutr (2018) 67:586–93. doi: 10.1097/MPG.0000000000002053
40. Szajewska H, Hoekstra JH, Sandhu B; ESPGHAN Working Group on Acute Diarrhoea. Management of acute gastroenteritis in Europe and the impact of the new recommendations: A multicenter study. The working group on acute diarrhoea of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr (2000) 30:522–7. doi: 10.1097/00005176-200005000-00011
41. American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis. Practice parameter: The management of acute gastroenteritis in young children. Pediatrics (1996) 97:424–35.
42. Bhatnagar S, Lodha R, Choudhury P, Sachdev HP, Shah N, Narayan S, et al. IAP guidelines 2006 on hospital-based management of severely malnourished children (adapted from the WHO Guidelines). Indian Pediatr (2007) 44:443–61.
43. Centers for Disease Control and Prevention. The management of acute diarrhea in children: Oral rehydration, maintenance, and nutritional therapy (1992). https://www.cdc.gov/mmwr/preview/mmwrhtml/00018677.htm [Accessed October 10, 2023].
44. NHS Pan Mersey Area Prescribing Committee. Lactose intolerance and cows’ milk protein allergy – Prescribing guidelines for specialist infant formula feeds (2021). https://www.panmerseyapc.nhs.uk/media/1192/infant_formula.pdf [Accessed October 10, 2023].
45. Wardlaw T, Salama P, Brocklehurst C, Chopra M, Mason E. Diarrhoea: Why children are still dying and what can be done. Lancet (2010) 375:870–2. doi: 10.1016/S0140-6736(09)61798-0.