Tuesday, August 10, 2010

Sucralose-Sweetened vs Rice-Based Oral Rehydration Solutions May Be More Palatable

From Medscape Medical News

Laurie Barclay, MD

August 6, 2010 — Sucralose-sweetened oral rehydration solutions may be more palatable than rice-based solutions, according to the results of a prospective, blinded, randomized 3-period, 3-treatment crossover trial reported in the August issue of the Archives of Pediatrics & Adolescent Medicine.

"Acute gastroenteritis accounted for more than 20 million episodes of diarrhea and 1.5 million outpatient visits annually in the United States by children younger than 5 years," write Stephen B. Freedman, MDCM, MSc, FRCPC, from The Hospital for Sick Children, University of Toronto in Ontario, Canada, and colleagues. "Therapy with oral rehydration solutions (ORSs) has reduced the mortality rates in underdeveloped countries, but its effect has been less dramatic in developed regions. Although this may be due to misperceptions regarding the need for extra time and effort to perform oral rehydration therapy, one possible explanation is that ORSs may not be appealing to children owing to their poor palatability."

The goal of this study was to compare the palatability of 3 oral rehydration solutions. The 2 solutions were sucralose sweetened (Pedialyte; Abbott Laboratories, Abbott Park, Illinois; and Pediatric Electrolyte; PendoPharm, Mont-Royal, Quebec, Canada), and 1 solution was rice based (Enfalyte; Mead Johnson Nutritionals, Evansville, Indiana).

At the emergency department of a tertiary care pediatric hospital, the investigators evaluated 66 children aged 5 to 10 years who presented with problems other than in the gastrointestinal tract. During a 15-minute period, the children were permitted to consume as much of each solution as they desired. Each child's taste rating on a 100-mm visual analog scale, where 0 mm was the worst taste and 100 mm was the best taste, was the main study endpoint. Volume consumed, willingness to drink each liquid again, and the most preferred liquid were secondary endpoints.

All participants completed all 3 study periods, with a carryover effect observed for taste scores (P = .03). These scores were significantly different with and without adjustment for the carryover effect (P < .001). Unadjusted taste scores were 65 mm for Pedialyte, 58 mm for Pediatric Electrolyte, and 23 mm for Enfalyte. Although differences in mean volume consumed were not significant (P = .44), the percentage of participants who said they would drink each beverage in the future was significantly different for Enfalyte vs Pediatric Electrolyte (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.11 - 0.46) and for Enfalyte vs Pedialyte (OR, 0.38; 95% CI, 0.25 - 0.57).

The best-tasting solution was identified as Pedialyte by 35 (53%) of 66 children, Pediatric Electrolyte by 26 (39%) of 66 children, and Enfalyte by 5 (8%) of 66 children (P < .001).

The OR of choosing Pedialyte vs Enfalyte was 12.3 (95% CI, 4.9 - 31.0) and vs Pediatric Electrolyte, 0.78 (95% CI, 0.44 - 1.4). Pediatric Electrolyte was preferred to Enfalyte (OR, 15.9; 95% CI, 6.0 - 41.7). No adverse effects were reported.

"Sucralose-sweetened oral rehydration solutions (Pedialyte and Pediatric Electrolyte) were significantly more palatable than was a comparable rice-based solution (Enfalyte)," the study authors write. "...Whether taste has a role in improving clinical outcomes remains unknown. Given the similar content of the solutions evaluated and that the sucralose solutions are less expensive, perhaps they should be recommended as initial therapy."

Limitations of this study include evaluation only of school-aged children without gastrointestinal tract complaints.

In an accompanying commentary, Peter Cummings, MD, MPH, from the University of Washington in Seattle, discusses the role of carryover bias as it affects this study.

"Despite the evidence of carryover bias reported by Freedman et al, their data still support their main findings," Dr. Cummings writes. "I doubt that carryover bias alone can explain the large taste score differences in their study; 2 sucralose solutions had tolerable flavor, while a rice-based solution tasted like dirt. But carryover bias could make it hard to interpret smaller taste score differences. Future studies of taste, and possibly other subjective outcomes, might be better conducted as parallel-group randomized studies."

The Paediatric Consultants Partnership's Grant for Creative Professional Activity supported this study. PendoPharm, a division of Pharmascience Inc, provided the Pediatric Electrolyte used in this study. The Hospital for Sick Children's Division of Nutrition Services provided the Enfalyte used in this study. The study authors and Dr. Cummings have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2010;164:696-702, 703-705. Abstract

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