***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Early feeding is generally recommended for children with acute diarrhea .  The concentration at which the milk should be given to children weaned at an early age remains a matter of debate . The aim of the study was therefore to evaluate the role of milk dilution in the first 24 hours on the outcome of diarrhea .  Sixty-nine well nourished and weaned children , aged 1 to 9 months and with moderate watery acute diarrhea were included after oral rehydration therapy ( ORT )  in a r and omised controlled study to receive either half-strength ( diluted group ) or full strength ( undiluted group ) milk . Both groups displayed the same clinical characteristics except for the weight . The outcome of the diarrhea until cessation was the same in the 2 groups . No failure requiring a specific treatment was observed . The duration of diarrhea and the total stool output were not statistically different in the 2 groups , i.e. 39 + /- 7 hrs in diluted vs 47 + /- 8 in undiluted , and 883 + /- 205 g in diluted vs 924 + /- 161 g in undiluted . These results are strengthened by the lack of significant differences in the weight gain , the number and volume of vomiting , the volume of ORT and milk intake . However , the energy intake was significantly higher in the group receiving full strength milk . These results suggest that there is no immediate clinical advantage to dilute the milk in the first 24 hours of feeding well nourished children with moderate acute watery diarrhea , if early feeding is associated with the ORT recommended by the WHO Recent studies have indicated that enteral diets can play an important role in the treatment of persistent diarrhea . Khitchri , a local weaning food in Pakistan , is composed of rice and lentils , which have previously been shown to be well tolerated in many children with acute diarrhea . The effectiveness of a khitchri and yogurt ( KY ) diet , which is inexpensive and widely available in Pakistan , was studied . One hundred two weaned boys ( 6 to 36 months old ) with persistent diarrhea were r and omly assigned to receive either soy formula ( group A ) or the KY diet ( group B ) for 14 days . Group A also received the KY diet in addition to formula for days 8 through 14 . Twenty-nine children did not complete the study because of severe infection ( 13 ) or their family 's decision to leave the study early ( 9 in group A and 7 in group B ) . Sixty-six children successfully completed the study protocol ; there were five clinical failures in group A and two in group B. On a comparable caloric intake , there was a significantly lower stool volume ( group B : 38 + /- 16 [ mean + /- SD ] vs group A : 64 + /- 75 g/kg per day , P less than .05 ) and frequency ( B : 4.4 + /- 2.0 vs. A : 6.6 + /- 4.2 stools per day , P less than .005 ) in children fed KY during the first week of therapy . Group B children also had a significantly greater weight gain than children in group A during the first week ( B : 468 + /- 373 g/wk vs A : 68 + /- 286 g/wk , P less than .005 ) . ( ABSTRACT TRUNCATED AT 250 WORDS There is concern that feeding full-strength animal milk to infants aged less than 6 months with diarrhoea may have adverse consequences . We assessed the effects on clinical course of two feeding regimens in 159 Guatemalan and Brazilian infants aged 2 weeks to 6 months who had had acute diarrhoea for 120 h or less , showed signs of mild to moderate dehydration , and had no complications . After correction of dehydration , infants were assigned r and omly to receive continued full-strength milk feeding or initial feeding with diluted milk with regrading to full-strength milk over 48 h. There were no significant differences between feeding groups in rate of treatment failures ( -1 % , 95 % Cl -14 to 12 % ) or mean ( SD ) total stool output ( full-strength milk 335 [ 268 ] g/kg , diluted milk 338 [ 354 ] g/kg ) and duration of diarrhoea ( 92 [ 50 ] vs 92 [ 44 ] h ) . A significant association was found between presence of reducing substances in stools and treatment failure ( OR 4.3 , 95 % CI 1.1 to 16.8 ) , but reducing substances in stools were common both in treatment successes ( 61 % ) and in failures ( 87 % ) . Our study supports the conclusion that , for infants under 6 months of age with diarrhoea whose only food is animal milk or formula , the milk or formula normally given should be provided in full strength as soon as dehydration has been corrected A r and omized clinical trial was completed to compare the efficacy of a mixed diet composed of locally available foods versus a lactose-free , soy-based formula for the management of young Mexican children with acute diarrhea and dehydration .  A total of 87 patients between 5 and 36 months of age received either a blended mixed diet containing rice , chicken , carrots , beans , and vegetable oil ( group MD ) or a soy formula ( group SF ) immediately after st and ard oral rehydration therapy . The initial clinical characteristics of the patients in each group were similar , as were their stool outputs during the first 6-hour period of rehydration before the diets were offered . There were six treatment failures , all of which were in group SF ( p < 0.01 ) . The stool outputs of children in group MD and in group SF were 82 + /- 55 versus 112 + /- 88 gm/kg per day , respectively , on day 1 ( p = 0.037 ) , and 48 + /- 33 versus 66 + /- 55 gm/kg per day on day 2 ( p = 0.109 ) . The duration of diarrhea among those in group MD was significantly reduced compared with those in group SF ( 29 vs 67 hours ; p < 0.001 ) . We conclude that the mixed diet result ed in improved clinical outcomes compared with the lactose-free , soy protein isolate formula A blind controlled trial was performed to test the hypothesis that early introduction of full-strength cow 's milk ( FCM ) during an attack of acute infantile gastroenteritis does not prolong the course of the illness . A total of 74 children matched for age was admitted to the trial , which compared the effect of FCM with that of graduated milk ( the strength of which was gradually increased ) . Thirteen children ( 17.5 % ) were withdrawn because of lactose malabsorption ; of those remaining , 29 were given FCM and 32 graduated milk . The mean duration of diarrhoea was 2,62 days for those on FCM and 2,64 days for those given graduated milk ( P = 0,71 , not significant ) . Early introduction of FCM therefore does not prolong the course of acute infantile gastroenteritis . Because of the prevalence of malnutrition in South Africa the practice of giving clear fluids or diluted milk during an attack of gastro-enteritis is unnecessary and dangerous OBJECTIVE To evaluate the effect of feeding infants a soy-based formula with lactose compared with a soy-based formula with sucrose during an acute diarrheal episode . PARTICIPANTS AND METHODS Two hundred boys , aged 3 to 18 months , who were admitted to the hospital with acute diarrhea and signs of dehydration were r and omly assigned to receive a soy-based formula with lactose or sucrose after initial rehydration . Intake and output ( stool , urine , and vomit ) were measured and recorded every 3 hours until diarrhea resolved . RESULTS The stool output during the first 24 hours of maintenance therapy , the total stool output during maintenance therapy , and the stool output during the entire illness ( measured in grams per kilograms ) were significantly lower among patients who received the soy-based formula with sucrose ( P<.05 , P<.001 , and P<.001 , respectively ) than among patients who received the soy-based formula with lactose . The duration of diarrhea was significantly shorter among patients who received the soy-based formula with sucrose ( P<.001 ) . The relative risk of being withdrawn from the study increased to 1.95 ( 95 % confidence interval , 0.65 - 9.2 ) and the relative risk of recurrence of dehydration after feeding was initiated increased significantly to 3.49 ( 95 % confidence interval , 1.1 - 9.6 ; P<.01 ) in the group receiving the soy-based formula with lactose . CONCLUSION During diarrheal episodes , feeding infants a soy-based formula with sucrose has a better outcome ( lower stool output , shorter duration of diarrhea , and lower failure rates ) than feeding infants a soy-based formula with lactose A double-masked clinical trial was conducted to assess the effects of inclusion of beans in a mixed diet for young Peruvian children with acute diarrhea . Dietary treatment consisted of either rice , beans , and vegetable oil ( group RB , n = 25 ) or rice , soy-protein isolate , corn syrup solids , and vegetable oil ( group RS , n = 21 ) , each given in amounts up to 150 kcal/kg body weight per day immediately following rehydration therapy . The groups were generally similar at the time of admission , and there were no differences in the rates of treatment failure ( 8 % in group RB , 14 % in group RS ; P = .65 ) . Mean stool outputs were 83 + /- 46 ( SD ) g/kg body weight in group RB and 71 + /- 43 g/kg body weight in group RS on day 1 , and these outputs consistently ranged from 25 % to 40 % greater in group RB than in group RS ( P = .058 ) . By contrast , the median duration of liquid stool excretion was substantially less in group RB than in group RS ( 60 vs 121 hours , P = .01 ) . The fractional absorption of carbohydrate , fat , and total energy was significantly greater by children in group RS , but there were no differences in net apparent absorption of these nutrients because the children in group RB consumed significantly more of their assigned diet . Children in group RS gained significantly more weight during the whole period of observation ( 194 g vs 1 g , P = .047 ) , but these differences could be entirely explained by the weight ( and presumably fluid ) changes on day 1 . There were no consistent differences by dietary group in any of the other anthropometric indicators . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE To determine whether the routine use of a lactose free formula ( AL-110 , Nestle Labs . ) in hospitalized children aged one to 24 months reduces the duration of acute diarrhea ( AD ) . METHODS After being stratified according to age and nutritional state , 28 and 24 patients were r and omly allocated to receive AL-110 or lactose formula  , respectively . The main outcome was the duration of diarrhoea after refeeding , both in hours and days . Secondary outcomes were evaluated by blind observers . Results were compared using t test , the Mann-Whitney test and Chi square . RESULTS No differences were found between the diets without and with lactose regarding duration of diarrhoea in hours ( mean , 41.9 h vs 54.4 h ; p = 0.247 ) or days ( median , 0 d vs 0 d ; p = 0.717 ) , the percentage of failures ( 3.6 % vs 8.3 ; p = 0.2 ) , and the mean weight increment ( 0.78 kg vs. 0.82 kg ; p = 0.788 ) . The study power to find a 50 % ( 27h ) reduction of AD duration was 71 % . CONCLUSION Although the power of this trial was slightly below that previously fixed ( 80 % ) , the results suggest that routine use of lactose free formula does not reduce the duration of AD in hospitalized children A r and omized clinical trial was completed to study the severity , duration , and nutritional outcome of acute diarrhea in 85 Peruvian children between 5 and 24 months of age who received a soy-protein-isolate , lactose-free formula ( group SF ) or one of two mixtures of home-available foods  , all in amounts up to 110 kcal/kg of body weight/day . The mixed diets contained either wheat flour , pea flour , carrot flour , sucrose , and vegetable oil ( group WP ) or potato flour , dried whole milk , carrot flour , sucrose , and oil ( group PM ) . The characteristics of the children in each group were generally similar initially . There were no differences in treatment failure rate by diet group . Fecal outputs were similar in all groups during the first day of treatment , averaging 60 to 65 g/kg/day . However , stool outputs were greater for the PM group than for other groups on days 3 and 4 , and were less for the SF group than the other groups on days 5 and 6 . The estimated median duration s of diarrhea in the WP group ( 52 h ) and PM group ( 53 h ) were significantly less than in the SF group ( 154 h , p = 0.005 ) . Energy intakes , energy absorption , and nitrogen retention ( % of intake ) were generally similar in all dietary groups , although there were minor differences in the absorption of specific macronutrients . Children in all groups gained weight during hospitalization , and there were no significant differences by diet group in the change in anth 
    Output:
    
Results Evidence of low-to-moderate quality suggests that among children with acute diarrhea , diluting or fermenting lactose-containing liquid feeds does not affect any outcome when compared with an ordinary lactose-containing liquid feeds .
In contrast , moderate quality evidence suggests that lactose-free liquid feeds reduce duration and the risk of treatment failure compared to lactose-containing liquid feeds in acute diarrhea .
Only limited evidence of low quality was available to assess either of these two approaches in persistent diarrhea , or to assess lactose-free liquid feeds compared to lactose-containing mixed diets in either acute or persistent diarrhea .
For commercially prepared or specialized ingredients compared to home-available ingredients , we found low-to-moderate quality evidence of no effect on any outcome in either acute or persistent diarrhea , though when we restricted these analyses to studies where both intervention and control diets were lactose-free , weight gain in children with acute diarrhea was shown to be greater among those fed with a home-available diet .
Conclusions Among children in low- and middle-income countries , where the dual burden of diarrhea and malnutrition is greatest and where access to proprietary formulas and specialized ingredients is limited , the use of locally available age-appropriate foods should be promoted for the majority of acute diarrhea cases .
Lactose intolerance is an important complication in some cases , but even among those children for whom lactose avoidance may be necessary , nutritionally complete diets comprised of locally available ingredients can be used at least as effectively as commercial preparations or specialized ingredients .