maltodextrin and Diarrhea--Infantile

Previously we reported that standard oral rehydration salts (ORS) solution is not as effective as a reduced-osmolarity glucose-based ORS for the treatment of children with acute noncholera diarrhoea: with standard ORS the diarrhoea lasts longer, stool output is greater, serum sodium is higher, and there is more need for supplemental intravenous infusion. We studied a reduced-osmolarity maltodextrin (MD)-based ORS to determine whether it had similar benefits, and also the effect of sugar malabsorption on the efficacy of standard and MD-based ORS. A total of 90 boys aged 3-24 months with acute noncholera diarrhoea and moderate dehydration were randomly assigned to either standard ORS (glucose 20 g/l, osmolarity 311 mmol/l) or MD-ORS (MD 50 g/l, osmolarity 227 mmol/l). There were no differences in treatment results. Some 46% of subjects had a high total stool output (> 300 g/kg), which was unrelated to the type of ORS given. High stool output was significantly associated with a longer duration of diarrhoea (33 vs. 15 hours; P < 0.001), a persistently elevated serum sodium (149 vs. 144 mmol/l at 24 h; P < 0.02), the need for intravenous infusion (11/41 vs. 0/48; P < 0.002), and an increase in faecal reducing substances (10.8 vs. 3.4 g/l at 24 h; P < 0.001). We conclude that some children given standard ORS develop osmotic diarrhoea owing to the combined effect of transient sugar malabsorption and slight hypertonicity of the ORS. Earlier studies show that this adverse outcome can largely be avoided when extra water is given in reduced-osmolarity glucose-based ORS. Reduced osmolarity has no benefit, however, when glucose is replaced by maltodextrin, probably because the sugars released by hydrolysis of MD, when malabsorbed, raise the intraluminal osmolarity to equal or exceed that of standard ORS. Thus, reduced-osmolarity glucose-based ORS is superior to both standard ORS and reduced-osmolarity solutions based on maltodextrin and probably other complex carbohydrates. Studies are in progress to define the optimal formulation of reduced-osmolarity glucose-based ORS.. At the Diarrhoeal Disease Research and Rehydration Centre of Bab El-Sha'reya Hospital in Cairo, Egypt, clinical researchers randomly assigned 90 fully weaned boys aged 3-24 months with non-cholera diarrhea and signs of moderate dehydration to either the treatment group receiving the standard glucose-based oral rehydration solution (ORS) or the group receiving a reduced-osmolarity ORS with minimally hydrolyzed maltodextrins (MD) (50 g/l) in place of glucose (20 g/l). They wanted to determine whether the reduced-osmolarity, MD-based ORS yielded similar benefits as the glucose-based ORS and to examine the effect of sugar malabsorption on the efficacy of both solutions. The osmolarity of the MD-based ORS was 227 mmol/l compared to 311 mmol/l for the standard ORS. There were no significant differences in the clinical outcomes (duration of diarrhea, stool output, ORS intake, serum sodium level, and weight gain at discharge) for each treatment group. High stool output had a significant positive association with longer duration of diarrhea (33 vs. 15 hours for low stool output; p 0.01), a persistently elevated serum sodium concentration (149 vs. 144 mmol/l for low stool output; p 0.02), the need for intravenous infusion (11/41 vs. 0/48 for low stool output; p 0.002), and an increase in substances that reduce feces (10.8 vs. 3.4 g/l for low stool output; p 0.001). Based on these findings, the researchers hypothesized that, like the standard ORS, the reduced osmolarity ORS, in which glucose is replaced with MD, also caused sugar malabsorption. The sugar malabsorption, in turn, increased the effective intraluminal osmolarity to equal or exceed that of the standard ORS. Both sugar malabsorption and intraluminal hypertonicity were responsible for a net flow of water from extracellular fluid into the gut, an increased serum sodium concentration, increased thirst leading to greater intake of ORS, ORS treatment failure, an increase in stool output, and an increase in duration of diarrhea. In conclusion, reduced-osmolarity, glucose-based ORS is superior to the standard glucose-based ORS and reduced-osmolarity, MD-based ORS.

Topics: Carbohydrate Metabolism; Child, Preschool; Diarrhea, Infantile; Double-Blind Method; Glucose; Humans; Infant; Intestinal Absorption; Male; Maltose; Osmolar Concentration; Polysaccharides; Rehydration Solutions

A double-blind, randomized controlled study was used to compare the efficacy and safety of an oral rehydration solution either with minimally hydrolyzed maltodextrins or the standard recommended glucose. One hundred twenty pediatric patients with acute watery diarrhea (60 in each group) were studied, but only 116 patients were included in the final analysis. After rehydration, outcome variables did not differ significantly at p < 0.05. Mean duration of diarrhea was 52.5 +/- 32.2 h for the control group (median, 50.8 h) and 57.2 +/- hours for the study group (median, 45.3 hours). Comparisons of the mean stool output, weight gain, and ORS intake on the 24th h and from admission to discharge were not statistically significant. Differences in laboratory parameters consisting of mean serum sodium, potassium, total CO2, hematocrit, plasma total solids, urine specific gravity, and random blood sugar were likewise not significant. Differences in stool pH and reducing sugars were statistically significant; however, the observed values were still within normal range. All laboratory values improved upon rehydration. Replacement of glucose with maltodextrins did not offer added advantages in reducing the duration and severity of diarrhea.

Topics: Blood Glucose; Child, Preschool; Diarrhea, Infantile; Feces; Fluid Therapy; Glucose; Hematocrit; Humans; Hydrogen-Ion Concentration; Infant; Male; Polysaccharides; Potassium; Rehydration Solutions; Sodium; Weight Gain

The efficacy and safety of malto-dextrin/glycine-based oral rehydration solution (ORS) when compared with the glucose-based oral rehydration solution (WHO) was evaluated in a randomized double-blind clinical trial. Thirty-one subjects and 31 controls were studied. The mean values of the ORS intake, stool output, duration of diarrhoea, urine output, weight gain and serum electrolytes were comparable in both the study and the control groups (p > 0.05). It was found that the malto-dextrin/glycine ORS offered no therapeutic advantage over the standard glucose ORS (WHO). In view of the accidental preponderance of children of significantly lower nutritional status among the control group (p < 0.05), it is likely that the efficacy of malto-dextrin/glycine ORS might actually be less than that of the glucose ORS.

Topics: Diarrhea, Infantile; Double-Blind Method; Fluid Therapy; Glucose; Glycine; Humans; Infant; Male; Polysaccharides; Rehydration Solutions; Treatment Outcome

Male children (N = 101) 6-35 months of age presenting with acute watery diarrhea for less than 48 h at home before hospitalization were admitted into a randomized, double-blind clinical trial. Fifty-one children were treated with standard oral rehydration solution (ORS) (World Health Organization [WHO] formulation containing citrate) and 50 were treated with an improved ORS formulation (containing, in addition to the standard formula, 20 g maltodextrin instead of glucose, and 4 g glycine and 4 g glycyl-glycine). None were given antibiotics. No i.v. infusions were given. Rotavirus was detected by enzyme-linked immunosorbent assay in stools of 43 children. Clinical characteristics of children in the two treatment groups were comparable. Improved ORS did not produce significant reduction in the volume of diarrhea stools. Children given improved ORS had greater weight gain than that observed in children treated with standard ORS, but the differences were not statistically significant except at the end of the first 24 h. Among children with rotavirus diarrhea, no significant differences were observed between the 23 children who received improved ORS and the 20 who received standard ORS.

Topics: Acute Disease; Breast Feeding; Child, Preschool; Citrates; Defecation; Diarrhea; Diarrhea, Infantile; Double-Blind Method; Electrolytes; Fluid Therapy; Glucose; Glycine; Glycylglycine; Humans; Infant; Male; Osmolar Concentration; Polysaccharides; Rehydration Solutions; Rotavirus Infections; Weight Gain

We compared the efficacy of a maltodextrin containing oral rehydration salts (ORS) solution with that of the WHO recommended glucose-ORS solution in a double blind randomized study of treating 69 children (33 in experimental group; 36 in control group) aged 4-36 months with acute diarrhoea causing mild to moderate dehydration. Both the groups of children were similar in initial clinical characteristics and received only ORS solutions. No significant differences in stool output (median 88.0, range 34-320 g/kg body wt. in experiment vs 75.0, 25-410 g/kg in control), intake of ORS solution (125.0, 58-360 ml/kg body wt. vs 154, 130-250 ml/kg), and duration of recovery from diarrhoea (2.0 d, range 1-6 vs 2.0 d, 1-9) were found between the groups. The haematocrit and serum electrolyte values in the two groups 24 hours after starting treatment were also similar. The results suggest that the ORS containing maltodextrin (50 g/l) in place of glucose has no advantage over WHO-ORS in correcting mild to moderate dehydration of children with acute diarrhoea.

Topics: Child, Preschool; Diarrhea, Infantile; Double-Blind Method; Fluid Therapy; Glucose; Humans; Infant; Polysaccharides; Rehydration Solutions

Topics: Diarrhea, Infantile; Humans; Hypernatremia; Infant; Polysaccharides; Rehydration Solutions

The protracted diarrhea of young infants with failure to thrive is a clinically defined severe illness. Starting from acute enteritis it will lead to a vicious circle of malnutrition, malabsorption and food intolerance. 17 infants have been treated with a special diet of the three components: 1. oligopeptides (lact-albumin enzymatic hydrolysate); 2. long-chain triglycerides; and 3. Maltodextrin 5 (corn hydrolysate). These components are mixed according to the individual clinical state and intestinal tolerance. Trace elements, minerals and vitamins are added. Our diet has proven a great help in reducing and even replacing parenteral nutrition.

Topics: Chronic Disease; Diarrhea, Infantile; Female; Humans; Infant; Infant, Newborn; Malabsorption Syndromes; Male; Oligopeptides; Polysaccharides; Triglycerides