Foods for the Treatment of Malnutrition

Summary of Conference Presentation

At the Dublin conference on Emergency Supplementary Feeding (February 18 to 21, 1997), reported on in the last issue of Field Exchange, Prof. Mike Golden of Aberdeen University gave a succinct overview of his work in developing suitable foods for the treatment of malnutrition. His main point was that "low recovery rates that are often reported in therapeutic and supplementary feeding programmes may be attributable to fundamental physiological changes and nutrient deficiencies that occur in malnutrition but are not adequately addressed by diets currently in use". His research has shown that the most appropriate diets for treating malnutrition should do two things:

• make up for nutrients that are normally stored in the body (Type 1 nutrients), e.g. iron, vitamin A, selenium, but have been depleted
• provide in higher than normal quantities in the severely malnourished, nutrients which cannot be stored and need to be consumed on a daily basis (Type 2 nutrients), e.g. amino acids, sodium and potassium.

Three feeding products have now been developed as a result of this work:

F75 (Phase 1 milk) is designed for use in the initial phase of the recovery process from severe malnutrition when metabolism is abnormal. The milk is modified to reduce the risk of diarrhoea. It has a lower osmolarity, sodium, fat and protein content and a higher carbohydrate content than F100. ACF is currently assessing this product in field.

F100 (Phase 2 milk) is a high energy milk with added minerals and vitamins. It is intended for the treatment of severely malnourished children once their condition has been stabilised (in phase 2 of therapeutic feeding) and is designed to maximise weight gain and reduce mortality rates. Evaluations of this product in ACF feeding centres have shown mortality and weight gain rates that are comparable to those achieved in the more controlled environment of a metabolic ward.

SP450 is a porridge fortified with vitamins and minerals. It can be used in phase 2 of therapeutic feeding and in supplementary feeding programmes. It is suitable for all ages. The product has been assessed in a number of ACF supplementary feeding programmes. Initial findings are summarised in the table below.

Issues and Challenges:

• F100 is relatively expensive at US$3,000 per tonne. However, a comparative economic evaluation, which would need to take into account the slower rate of recovery in children given less appropriate foods, could show that F100 is actually more cost-effective
• Future developments will focus on designing a "take home" equivalent of F100 to facilitate home treatment of severe malnutrition. This may be of use for programmes in poor security situations.
• F100 is approved and recommended by UNICEF for therapeutic feeding. Stocks of F100 will be stored in countries where therapeutic nutrition programmes are operational.
• SP450 is now being produced in Kenya at US$ 1000 per tonne (compared to US$600 for normal porridges). Initial findings have shown that this locally made porridge can achieve up to five times the weight gain of that attained using other local porridges.

For further information contact: Professor Mike Golden, Department of Medicine and Therapeutics, University of Aberdeen, Forresterhill, AB9 2ZD. Tel. No. +44 1 224 681818 e-mail: m.golden@abdn.ac.uk