Efficacy of F-100, diluted F-100, and infant formula for treatment of infants under six months with severe acute malnutrition

View this article as a pdf

Research snapshot¹

A double-blind randomised clinical trial was conducted between March 2012 and January 2015 to assess the efficacy and safety of F-100, diluted F-100 (F-100D), and infant formula (IF) for dietary management in the rehabilitation phase of the management of severe acute malnutrition (SAM) of infants under six months of age. Infants (n = 153) were enrolled at the Nutrition Rehabilitation Unit of Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in Dhaka and were randomly assigned to any of the three diets after stabilisation. Two ml blood was collected on study days 1, 3, and 7 for measuring serum electrolytes, creatinine and osmolality, urine samples for specific gravity and osmolality creatinine ratio. Renal solute load (RSL) and potential RSL were calculated. Infants were discharged when they had gained 15% of their admission body weight or had oedema-free weight-for-length z-score (WLZ) ≥ - 2.

Results showed that infants fed F-100 and F-100D had higher weight gain than infants who received IF. The mean difference between F-100 and IF was 4.6 g/kg/d (95% CI 1.5–7.6, P = 0.004). The mean difference between F-100D and IF was 3.1 g/kg/d (95% CI 0.6–5.5, P = 0.015). Total energy intake from the study diet and breastmilk was significantly higher in infants fed F-100 compared with the other two diets (P = 0.001 in each case). RSL was highest in infants fed F-100, but serum sodium showed no sign of elevation. Urinary specific gravity and serum sodium values were within normal range. Controversy about feeding F-100 has concerned its renal solute load and the possible risk of negative water balance and hypernatraemic dehydration. As expected, the estimated renal solute load was lower than the potential renal solute load in all three groups as solutes were being deposited in tissue growth. The authors conclude that F-100 can be safely used in the rehabilitation phase for infants under six months of age with SAM and there is no need to prepare alternative formulations.

Endnote

¹Islam, M.M., Huq, S., Hossain, M.I. et al. Eur J Nutr (2019). https://doi.org/10.1007/s00394-019-02067-5