Efficacy of partially hydrolyzed guar gum (PHGG) supplemented modified oral rehydration solution in the treatment of severely malnourished children with watery diarrhoea: a randomised double-blind controlled trial.

Nur Haque Alam,Mohammad Kamruzzaman,Sufia Islam,Maryam Kadjar Olesen,Tahmeed Ahmed,Hasan Ashraf,Remy Meier,Niklaus Gyr

doi:10.1186/s41043-015-0003-3

Abstract

ObjectivesTo examine whether PHGG added ORS reduce duration of diarrhoea, stool output and enhance weight gain.MethodsIn a double-blind controlled clinical trial, 126 malnourished children (weight for length/weight for age < −3 Z-score with or without pedal edema), aged 6 – 36 months with acute diarrhoea <7 days were studied in two treatment groups; 63 received modified WHO ORS (Na 75, K 40, Cl 87, citrate 7, glucose 90 mmol/L) with PHGG 15 g/L (study group); 63 received modified WHO ORS without PHGG (control). Other treatments were similar in both groups. The study protocol was approved by Ethics Committee of icddr,b; the study was carried out at the Dhaka Hospital.ResultsThe mean duration of diarrhoea (h) was significantly shorter in children of the study group (Study vs. control, mean ± SD, 57 ± 31 vs. 75 ± 39, p = 0.01). Although there was a trend in stool weight reduction in children receiving ORS with PHGG (study vs. control, stool weight (g), mean ± SD; 1st 24 hour, 854.03 ± 532.15 vs. 949.11 ± 544.33, p = 0.32; 2nd 24 hour, 579.84 ± 466.01 vs. 761.26 ± 631.64, p = 0.069; 3rd 24 hour, 385.87 ± 454.09 vs. 495.73 ± 487.61, p = 0.196), especially in 2nd 24 h period, the difference was not statistically significant. The mean time (day) to attain weight for length 80% of NCHS median without edema was significantly shorter in the study group (study vs. control, mean ± SD, 4.5 ± 2.6 vs. 5.7 ± 2.8, p = 0.027).ConclusionPHGG added to ORS substantially reduced duration of diarrhoea. It also enhanced weight gain. Further studies might substantiate to establish its beneficial effect.Clinical trial registration numberNCT01821586

Highlights

The median case fatality rate of severely malnourished children has remained as high as 20 to 26% for many years, despite improved understanding of the pathophysiology and treatment of these children [1]
Recruitment and participant flow In total 190 children attending the icddr,b Dhaka Hospital for treatment were screened for this study (Figure 1), of whom 126 children were randomized; 63 received modified WHO- ORS plus Partially hydrolyzed guar gum (PHGG) 15 g/L and 63 received modified WHO-ORS alone
During the study period after randomization, 6 patients were withdrawn from the study group before diarrhoea stopped

Summary

Introduction

The median case fatality rate of severely malnourished children has remained as high as 20 to 26% for many years, despite improved understanding of the pathophysiology and treatment of these children [1]. It only highlights the widespread failure to use treatments that have been known for many years. Alam et al Journal of Health, Population and Nutrition (2015) 34:3. Since diarrhoea is associated with further loss of weight and deficiency of macro- and micronutrients, early recovery along with lessening of diarrhoea severity will help to prevent further weight loss and deficiency of these nutrients in severely malnourished children. Severely malnourished children have depleted potassium stores, and diarrhoea further depletes the serum potassium concentration [5]. Recovery from diarrhoea will prevent further deficits of serum potassium concentration and total body stores

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