Page 109 - 15Diarrhoeaandvomiting

Diarrhoea and vomiting caused by gastroenteritis in children under 5 years

The two groups had similar characteristics at the start of the study. Five patients were considered
treatment failures (two in the rice bean group and three in the rice soy group). The mean energy
consumption was similar between the two groups up to day 4, but consumption was greater in
the rice bean diet group compared with the rice soy diet group on day 5 (161.8 ± 17.5 kcal/kg
per day versus 138.8 ± 21.0 kcal/kg per day; P < 0.001) and day 6 (161.8 ± 13.7 kcal/kg per day
versus 144.6 ± 20.1 kcal/kg per day; P < 0.001). There were no differences between the two diet
groups regarding the overall weight gain or length of hospital stay but the duration of diarrhoea
was significantly less in the rice bean group compared with the rice soy group (60 hours versus
121 hours; P = 0.01). [EL = 1−]

Two of the RCTs compared the use of porridge in different consistencies.
In one Bangladeshi study, 129 infants aged 6–23 months with a history of watery diarrhoea of less
than 72 hours’ duration and three or more liquid stools in the 24 hours before admission were
recruited. Those with systemic infections (pneumonia, bacteria or other complications) or severe
malnutrition were excluded. The children were randomly assigned (using separate randomisation
lists for under and over age 1 year and coded envelopes) to either amylase-treated wheat porridge
(n = 32), unaltered thick porridge (n = 32) or porridge diluted with water (n = 31). Participants were
stabilised with oral or IV rehydration therapy as necessary and a hospital milk–cereal mixture diet
for 24 hours. The three groups had similar characteristics at the start of the study although overall
more boys were younger than 1 year. Blinded assessors measured outcomes daily for 5 days. The
mean intake of porridge and the total energy intake was greatest in the amylase-treated porridge
group (ANOVA P < 0.001) but there were no statistically significant differences in weight change
or duration of diarrhoea among the three groups. Significantly fewer children in the unaltered
thick porridge group vomited at day 2 than in the amylase-treated porridge group (40.6% versus
76%; P < 0.01) or dilute porridge group (40.6% versus 64.5%; P < 0.01), but there were no
further differences among groups up to day 5. [EL = 1+]
The second study 130 was conducted in Tanzania and recruited children aged 6–25 months who
had been hospitalised for acute watery diarrhoea (defined as stools more watery and more
frequent than usual, and for less than 14 days based on parent’s history, and severe enough to
require hospital admission). Unweaned children or those with a congenital or chronic condition
interfering with food intake or kwashiorkor were excluded, as were children discharged after
only 1 day and children requiring nasogastric feeding tubes. Rehydration therapy (according to
WHO guidelines) was given as necessary before children were randomly assigned (using block
randomisation lists and sealed envelopes) to feeding with either normal corn porridge (n = 26),
amylase-digested porridge (n = 25) or fermented and amylase-digested porridge (n = 24). The three
groups had similar characteristics at the start of the study. There were no statistically significant
differences in duration of diarrhoea, recurrence of diarrhoea, median weight change or the need
for IV rehydration therapy between the three groups at any point. There were a total of four
deaths during the trial – one from pneumonia in the fermented and amylase-digested porridge
group and three in the amylase-digested porridge group, where two children died of pneumonia
and one from suspected septicaemia. However, the mean daily energy intake on days 1–4 was
greater in the amylase-digested porridge group compared with the normal porridge group (46.0
± 1.4 kcal/kg per day versus 32.4 ± 1.4 kcal/kg per day; P = 0.003). The study did not state the
mother/child preference. [EL = 1+]
Three of the RCTs compared solid food with soy formula.
Infants aged 5–24 months with diarrhoea (more than three stools per day) for less than 96 hours
were recruited in a trial conducted in Peru. 131 Exclusion criteria were the use of antibiotics (more
than one dose), breastfeeding (one feed per day), malnutrition (>2 SD below the international
reference data) or a diarrhoeal episode in the previous 2 weeks. Children were randomly assigned
(fixed interval, block randomisation to allow for age and dehydration confounders) to either a
soy-based lactose-free formula (n = 29), wheat peas diet (wheat flour, pea flour, carrot flour,
soybean oil, cotton seed oil, sugar) (n = 28) or potato milk diet (potato flour, dry whole milk,
carrot flour, soybean oil, cotton seed oil, sugar) (n = 28). The allocation of interventions was not
masked. The three groups had similar characteristics at the start of the study although the soy
formula group were slightly older than the other groups. There were five treatment failures – one
in the soy formula group and two each in the wheat peas diet and potato milk diet groups. There
were no statistically significant differences in energy intake or weight gain between the three

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