Acceptability of coconut sugar-based oral rehydration solution for children with acute gastroenteritis

Abstract

Background: Palatability is an important determinant of adherence to oral rehydration therapy, particularly in children with acute gastroenteritis, as poor taste acceptability may limit the volume of oral rehydration solution consumed. Coconut sugar is a naturally derived carbohydrate source with a distinctive flavor profile and is widely consumed in Southeast Asia. These characteristics provide a rationale for investigating coconut sugar as an alternative carbohydrate source in an oral rehydration solution.

Objectives: To compare the acceptability of a coconut sugar-based rehydration solution with standard ORS in children with acute gastroenteritis, and to descriptively assess adverse events and exploratory clinical outcomes.

Methods: In this double-blind randomized controlled trial, 59 pediatric inpatients (<72 months) with mild-to-moderate dehydration were randomized to a coconut sugar-based rehydration solution (CO group; n=28) or standard glucose-based ORS (SO group; n=31). Acceptability was assessed initially and at 24 hours using researcher-observed responses, a facial hedonic scale, a visual analogue scale (VAS), and caregiver assessment. ORS intake, intravenous fluid administration, clinical parameters, and laboratory findings were analyzed as exploratory secondary outcomes.

Results: No statistically significant differences in acceptability were observed between groups. “Like” ratings on the facial hedonic scale were 50.0% in the CO group and 36.7% in the SO group (p value 0.535); mean VAS scores were 68.3 ± 17.5 versus 62.1 ± 20.4 mm (p value 0.258); and caregiver-reported “like” responses were 51.7% versus 34.6% (p value 0.608), respectively. Median 24-hour study-solution intake was low (90 vs 30 mL; p value 0.988), while substantial intravenous fluid was administered in both groups. No adverse events attributable to the study solutions were observed.

Conclusion: Measured acceptability did not differ significantly between the coconut sugar-based rehydration solution and standard ORS. Because oral intake was low and intravenous fluid administration was substantial, this study cannot establish comparative rehydration efficacy or therapeutic equivalence.In addition, the osmolality and complete electrolyte composition of the coconut sugar-based solution were not measured. Further formulation and clinical studies are required.