What are Therapeutic Milks?
Therapeutic milks, specifically F-75 and F-100, are specialized, nutritionally dense formulations developed to treat severe acute malnutrition (SAM), particularly in young children. Their development follows a two-phase protocol established by the World Health Organization (WHO), which prioritizes stabilizing a fragile patient before attempting rapid weight restoration. These formulas are administered under strict medical supervision in hospitals or therapeutic feeding centers and are not suitable for healthy individuals.
F-75: The Stabilization Formula
The F-75 therapeutic milk, often confused with 'F-70', is the cornerstone of the initial treatment phase (Phase 1) for SAM. This phase is focused on stabilizing the child's metabolic state and correcting life-threatening complications, not on weight gain.
Key characteristics of F-75 include:
- Low Energy and Protein: With an energy density of approximately 75 kcal per 100 ml and a low protein content, it is designed to be gentle on the recovering metabolic system.
- Low Sodium and Iron: It is formulated with low levels of sodium and iron to manage electrolyte imbalances and prevent iron toxicity, which can occur during the initial recovery period.
- High Carbohydrate: A higher proportion of carbohydrates helps stabilize blood sugar levels and prevents hypoglycemia.
Purpose in Phase 1:
- Metabolic Stabilization: Addresses severe complications like hypoglycemia, hypothermia, and severe electrolyte imbalances.
- Preventing Refeeding Syndrome: The careful, controlled reintroduction of nutrients prevents the dangerous shift of electrolytes that defines refeeding syndrome.
- Hydration: Provides essential fluid intake for a child who is often dehydrated due to severe illness.
F-100: The Rehabilitation Formula
Once the child is stabilized and begins to regain an appetite, they transition from F-75 to F-100 for the second phase of treatment (Phase 2), known as the rehabilitation phase.
Key characteristics of F-100 include:
- High Energy and Protein: Provides approximately 100 kcal per 100 ml, with a significantly higher protein content compared to F-75, to support rapid weight gain and tissue rebuilding.
- High Fat: The formula is also higher in fat, offering a concentrated energy source for recovery.
- Higher Sodium and Minerals: Contains higher levels of sodium, potassium, and other minerals to help replete body stores and support rapid growth.
Purpose in Phase 2:
- Catch-up Growth: The primary goal is to promote rapid weight gain and rebuild tissues that have been wasted due to malnutrition.
- Nutrient Repletion: Replenishes the body's depleted stores of macronutrients, vitamins, and minerals.
- Preparation for Normal Diet: Serves as a bridge to eventually transitioning the child to a normal, locally available diet.
The Phased Approach and Refeeding Syndrome
Refeeding syndrome is a potentially fatal metabolic complication that can occur when a severely malnourished person is fed too aggressively. The body, in its starved state, relies on fats and proteins for energy. When carbohydrates are suddenly reintroduced, it causes a sharp spike in insulin, triggering a rapid shift of electrolytes (like phosphorus, potassium, and magnesium) from the blood into the cells. This can lead to critical organ system failure.
The WHO protocol, which mandates the use of the lower-caloric, lower-protein F-75 first, is specifically designed to mitigate this risk. It allows the child's body to gently and safely readapt to normal metabolism before the high-energy F-100 is introduced to facilitate catch-up growth.
Comparison Table: F-75 vs. F-100
| Feature | F-75 Therapeutic Milk | F-100 Therapeutic Milk |
|---|---|---|
| Energy Density | Approximately 75 kcal/100 ml | Approximately 100 kcal/100 ml |
| Treatment Phase | Stabilization (Phase 1) | Rehabilitation (Phase 2) |
| Primary Goal | Stabilize metabolism, treat complications, prevent refeeding syndrome | Promote rapid weight gain and catch-up growth |
| Protein Content | Low (~1.0 g/100 ml) | High (~2.9 g/100 ml) |
| Fat Content | Low (~2.5 g/100 ml) | High (~4.7-7.0 g/100 ml) |
| Carbohydrate Content | High (~12 g/100 ml) | Moderate (~8.4-9.92 g/100 ml) |
| Sodium/Minerals | Low | Higher |
| Duration of Use | Typically used for the initial stabilization period | Used until target weight is reached or transitioning to RUTF |
Conclusion
In essence, the crucial difference between F70 and F-100 (more accurately, F-75 and F-100) lies in their distinct nutritional compositions and their specific roles within the multi-phase treatment of severe acute malnutrition. F-75 is a carefully formulated low-energy feed for initial stabilization, designed to correct severe metabolic disturbances and manage the risks of refeeding syndrome. Only after the patient's condition has been stabilized does the higher-energy, growth-promoting F-100 enter the therapeutic regimen. This sequential approach, based on extensive WHO guidance, is vital for ensuring a safe and effective recovery for severely malnourished individuals.
World Health Organization guidelines on the management of severe acute malnutrition provide detailed technical specifications and protocols for the use of these therapeutic foods.
