Effects of Lactose‑Restricted Regimen in Breastfeeding Children with Acute Diarrhea

Sanaz Mehrabani, Mohammadreza Esmaeili, Leila Moslemi, Reza Tarahomi


Background: Acute diarrhea is a major cause of mortality in children. Few studies have addressed the administration of lactose‑restricted diets in breastfed children with acute diarrhea. The present study was conducted to investigate the effects of a lactose‑restricted regimen on breastfed children with acute diarrhea treated with zinc supplements.

Methods: The present single‑blind randomized clinical trial was conducted on children aged 6‑24 months in Amirkola Children’s Hospital (2015‑2017). 90 children were randomly assigned to two groups. Group A was daily treated with 20 mg of zinc and a lactose‑restricted diet and breast milk for two weeks.Group B  received 20 mg of zinc and breast milk and an age‑appropriate diet for two weeks. The data collected in all the subjects included the frequency of diarrhea and the mean duration of hospitalization and recovery from diarrhea.

Results: The two groups were not significantly different in terms of mean age, weight and ratio of males to females. The mean duration of hospitalization
was found to be 3.1 ± 0.8 days in group A and 3.2 ± 0.6 in group B (P = 0.3), the mean duration of recovery to be 2.9 ± 0.8 in group A and 2.6 ± 1.1 in group B (P = 0.2) and the mean frequency of diarrhea 2.9 ± 0.7 in group A and 2.8 ± 0.8 days in group B (P = 0.5), suggesting no significant differences between the two groups. No adverse effects associated with zinc therapy were reported.

Conclusions: A lactose‑restricted regimen was found not to be beneficial for children with acute diarrhea under continuous breastfeeding and zinc therapy.

Keywords: Breastfeeding, children, diarrhea, lactose‑restricted, zinc

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Saneian H, Yaghini O, Modaresi M, Razmkhah N. Lactose‑free

compared with lactose‑containing formula in dietary management

of acute childhood diarrhea. Iran J Pediatr 2012;22:82‑6.

Lazzerini M, Ronfani L, Oral zinc for treating diarrhoea in

children. Cochrane Database Syst Rev 2008;3:1‑104.

Dekate P, Jayashree M, Singhi SC. Management of acute

diarrhea in emergency room. Indian J Pediatr 2013;80:235‑46.

Crisinel PA, Verga ME, Kouame KS, Pittet A, Rey‑Bellet CG,

Fontaine O, et al. Demonstration of the effectiveness of zinc

in diarrhoea of children living in Switzerland. Eur J Pediatr


Simakachorn N, Tongpenyai Y, Tongtan O, Varavithya W.

Randomized, double‑blind clinical trial of a lactose‑free and

a lactose‑containing formula in dietary management of acute

childhood diarrhea. J Med Assoc Thai 2004;87:641‑9.

Xu JH, Huang Y. Efficiency of lactose‑free formula feeding

as an adjunctive therapy in infants with acute diarrhea. CJCP


MacGillivray S, Fahey T, McGuire W. Lactose avoidance

for young children with acute diarrhoea. Cochrane Database

Syst Rev 2013:CD005433. doi: 10.1002/14651858.CD005433.


Wall C, 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.

Dalgic N, Sancar M, Bayraktar B, Pullu M, Hasim O. Probiotic,

zinc and lactose‑free formula in children with rotavirus diarrhea:

Are they effective? Pediatr Int 2011;53:677‑82.

World Health Organization. Diarrheal disease, fact sheet No 330.

Available from: http://www.who.int/mediacentre/factsheets/fs330/

en/. [Last accessed on 2019 Jul 29].

Johnston BC, Shamseer L, da Costa BR, Tsuyuki RT, Vohra S.

Measurement issues in trials of pediatric acute diarrheal diseases:

A systematic review. Pediatrics 2010;126:e222‑31.

Hartawan INB, Soenarto SY, Suandi I. Effectiveness of

lactose‑free formula in management of acute rotavirus diarrhea.

Paediatr Indones 2009;49:299‑303.

Dinleyici EC, Martínez‑Martínez D, Kara A, Karbuz A,

Dalgic N, Metin O, et al. Time series analysis of the microbiota

of children suffering from acute infectious diarrhea and their

recovery after treatment. Front Microbiol 2018;9:1230.

Guarino A, Albano F, Ashkenazi S, Gendrel D, Hoekstra JH,

Shamir R, et al. European society for paediatric gastroenterology,

hepatology, and nutrition/european society for paediatric

infectious diseases evidence‑based guidelines for the management

of acute gastroenteritis in children in Europe: Executive

summary. J Pediatr Gastroenterol Nutr 2008;46:619‑21.

Brown KH, Peerson JM, Fontaine O. Use of nonhuman milks in

the dietary management of young children with acute diarrhea:

A meta‑analysis of clinical trials. Pediatrics 1994;93:17‑27.

Saunders N, Friedman JN. Lactose avoidance for young children

with acute diarrhea. J Paediatr Child Health 2014;19:529.

Simakachorn N, Tongpenyai Y, Tongtan O, Varavithya W.

Randomized, doubleblind clinical trial of a lactose‑free and

a lactose‑containing formula in dietary nanagement of Acute

Childhood Diarrhea J Med Assoc Thai 2004;87641‑9.

Porrostami K, Arjmand R, Asayesh H, Noroozi M, Safari O,

Qorbani M. Effectiveness of GASTROFIX on duration of

diarrhea and length of Hospitalization in children with acute

gastroenteritis: A randomized controlled Trial Int J Pediatr


Bresee JS, Duggan C, Glass RI, King CK. Centers for Disease

Control and Prevention. Managing acute gastroenteritis among

children: Oral rehydration, maintenance, and nutritional therapy.

MMWR Recomm Rep 2003;52(RR16):1‑16.

Bajait C, Thawani V. Role of zinc in pediatric diarrhea. Indian J

Pharmacol 2011;43:232‑5.

Passariello A, Gianluca T, Giulio DM, Gaetano C, Serena R,

Antonio M, et al. Efficacy of a new hypotonic oral rehydration

solution containing zinc and prebiotics in the treatment of

childhood acute diarrhea: A randomized controlled trial. J Pediatr


Yoon PW, Black RE, Moulton LH, Becker s. Effect of not

breastfeeding on the risk of diarrheal and respiratory mortality

in children under 2 years of age in Metro Cebu, The Philippines.

Am J Epidemiol 1996;143:1142‑8.

Lopez‑Alarcon M, Villalpando S, Fajardo A. Breast‑feeding

lowers the frequency and duration of acute respiratory infection

and diarrhea in infants under six months of age. J Nutr