In a meta-analysis including 29 trials with a total of 2215 subjects assessing whether lactose-containing diet causes a treatment failure in acute diarrhoea, children with mild or no dehydration and those who are managed according to appropriate treatment protocols have similar treatment failure whether they receive lactose or not 1.
In all 13 studies (873 patients) the relative risk of treatment failure for children on lactose-containing diets was 2.1 (95% CI: 1.6-2.7) compared to children who did not receive lactose (p <0.0001, absolute difference 22% vs 12%, respectively). However, the excess treatment failure rates occurred only in those studies that included patients whose initial degree of dehydration, as reported by authors, was severe, or that were conducted before 1985, when appropriate diarrhea treatment protocols were first widely accepted. Among studies of patients with mild diarrhea, all but one of which were completed after 1985, the overall treatment failure rates in the lactose groups were similar to the rates in the lactose-free groups (13% vs 15%).
According to the authors´ conclusion, routine use of lactose-free milk or dilution of milk are not necessary, especially when oral rehydration therapy and early feeding form the basic approach to the management of diarrhoea in infants and children.
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies).
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