The efficacy of fermented foods in the treatment and management of diarrhoeal diseases: A systematic review and meta-analysis.

Nutrition and health. 2023;29(1):71-83

Plain language summary

According to World Health Organisation (WHO), diarrhoeal disease is the second leading cause of death among children under the age of 5 in the world. The WHO’s recommendation for the treatment of diarrhoea is oral rehydration solution (ORS), consisting of a solution of clean water, sugar and salt along with a 10-14 day supplemental treatment course of dispersible 20 mg zinc tablets. The aim of this study was to evaluate the available evidence with respect to the efficacy of fermented foods and beverages in comparison with unfermented or heat-treated products, including dairy and cereal products, focussing on the treatment of diarrhoea in infants. This study is a systematic review and meta-analysis of seven randomised controlled trials. Results show that administering fermented foods during an episode of diarrhoea in infants under five years of age, may reduce the duration of the disease in comparison to the control groups. There was no clear effect on daily stool frequency, but duration of hospitalisation was reduced following administration of fermented foods. Authors conclude that fermented foods may be helpful in the treatment of diarrhoea in infants up to the age of five. Thus, more good quality trials are required to investigate the complex matrix of fermented food products, other than dairy foods, in the management, particularly treatment of gastrointestinal diseases such as diarrhoea.

Abstract

Background: Diarrhoeal disease is a major cause of global infant mortality, and compromises the ability of many countries with respect to achieving sustainable development goals. The WHO's recommendation of Oral Rehydration Solution (ORS) and zinc in the management of this disease, may not be readily available. Consideration and assessment of cultural practices in its management has been an area of increased interest over the last decade. Aim: This study aims to systematically evaluate efficacy of the consumption of traditional fermented foods as functional products for the treatment and management of diarrhoea. Methods: Following PRISMA guidelines, a systematic review was conducted of electronic databases (Cochrane Library, Ovid Medline and Pubmed) databases with no restrictions on language and publication date for RCTs that investigated the effect of consumption of fermented foods on the treatment of diarrhoea in children under five years of age. Results: Seven RCTs were included. Meta-analysis showed that compared to control, consumption of fermented foods significantly reduced mean duration of diarrhoea, -0.61 days; (95% CI, -1.04, -0.18); length of hospitalization, -0.35 days (95% CI, -0.69, -0.02); but not mean daily frequency of stool -2.00 (95% CI,-7.03, 3.04). Conclusion: Limited available evidence suggests that consumption of fermented foods may help reduce duration and severity of symptoms as a treatment of diarrhoea. More high quality research needs to be undertaken to investigate the efficacy of fermented food as an effective alternative to ORS as a potential WHO recommendation for management of diarrhoeal disease.

Lifestyle medicine

Fundamental Clinical Imbalances : Digestive, absorptive and microbiological
Patient Centred Factors : Mediators/Diarrhoeal disease
Environmental Inputs : Diet ; Nutrients ; Microorganisms
Personal Lifestyle Factors : Nutrition
Functional Laboratory Testing : Not applicable
Bioactive Substances : Probiotics

Methodological quality

Jadad score : Not applicable
Allocation concealment : Not applicable

Metadata