The F-75 therapeutic diet is a cornerstone of the World Health Organization's (WHO) protocol for managing Severe Acute Malnutrition (SAM), particularly in young children with medical complications. It is a carefully formulated milk-based feed (or sometimes cereal-based, depending on the variant) with specific nutritional properties that are tailored to the fragile metabolic state of a severely malnourished patient. Unlike subsequent therapeutic diets, F-75 is not intended for rapid weight gain. Its primary purpose is to safely and gently correct dangerous metabolic and electrolyte imbalances, support rehydration, and prevent complications like heart failure. The "75" in its name refers to the 75 kilocalories per 100ml energy density of the prepared formula.
The Purpose of the F-75 Diet
When a child is severely malnourished, their body undergoes significant physiological changes, including electrolyte disturbances (such as low potassium and high sodium) and impaired liver and kidney function. Feeding a high-protein, high-energy diet immediately can overwhelm these fragile systems and lead to fatal refeeding syndrome. The F-75 diet is specifically formulated to prevent this.
Key functions of the F-75 diet:
- Stabilizing metabolic function during the most critical phase of treatment.
- Correcting severe electrolyte imbalances without overstressing the body.
- Providing sufficient energy in the form of carbohydrates to sustain the child.
- Minimizing the strain on the kidneys with low protein and sodium levels.
- Supporting gentle rehydration, which is often compromised in severely malnourished children.
- Preventing heart failure, a common complication during refeeding.
Key Components of the F-75 Formula
The standard F-75 formula is a milk-based powder consisting of several core ingredients designed to meet the specific needs of a stabilizing patient.
Ingredients list:
- Milk Powder: Provides a low-protein dairy base. At least 50% of the protein in the formula must come from dairy protein.
- Vegetable Oil: Supplies energy and essential fatty acids, though in a measured concentration.
- Carbohydrates: Often a mix of sugar (saccharose) and maltodextrin, providing readily available energy to the child's body.
- Vitamin and Mineral Mix: Contains essential micronutrients like potassium, magnesium, zinc, and a full spectrum of vitamins, excluding iron. Iron is typically withheld during the stabilization phase to prevent complications, especially in the presence of infection.
Alternative versions exist, such as cereal-based or low-lactose formulas, which are sometimes used for children with persistent diarrhea or specific intolerances.
The Two-Phase Treatment: F-75 vs. F-100
The F-75 diet is the first step in a two-part nutritional recovery process, followed by the F-100 diet. The differences are crucial for a child's safe recovery.
| Feature | F-75 (Stabilization Phase) | F-100 (Rehabilitation Phase) |
|---|---|---|
| Purpose | Stabilize metabolism, correct electrolyte imbalance | Promote rapid weight gain and nutritional recovery |
| Energy Density | ~75 kcal per 100 ml | ~100 kcal per 100 ml |
| Protein Content | Low (~5% of total energy) | High (~10-12% of total energy) |
| Fat Content | Low (~32% of total energy) | Higher (~45-50% of total energy) |
| Sodium Content | Low | Normal |
| Iron | Low or absent | Present |
How the F-75 Diet is Administered
F-75 is only given under strict medical supervision in an inpatient hospital or therapeutic feeding center.
Administration steps:
- Preparation: The powdered formula is meticulously measured and mixed with a specific amount of previously boiled, cooled water to ensure the correct concentration. Incorrect mixing can lead to fluid overload or insufficient energy intake.
- Dosage: Feeds are given frequently, typically every 2 to 3 hours, in small volumes. The precise amount is determined by a healthcare provider based on the child's weight and condition.
- Feeding Method: Very weak children may receive the feed via a nasogastric tube. For those with a good appetite, cup or spoon feeding is used.
- Monitoring: The child's vital signs, hydration status, and progress are constantly monitored to prevent complications.
Transitioning to Recovery
Once a child shows clear signs of metabolic stabilization, including reduced edema and a returning appetite, they are moved to the next phase of treatment. This involves a gradual transition to the higher-energy F-100 formula or a Ready-to-Use Therapeutic Food (RUTF) over several days. This careful transition ensures the recovering body can handle the increased nutritional load without experiencing shock. RUTFs are often used in outpatient settings to allow for continued recovery at home once medically stabilized.
The Role of the F-75 Diet in Global Health
The systematic use of therapeutic diets like F-75 and F-100, guided by WHO protocols, has dramatically improved outcomes for children with severe malnutrition. Organizations like UNICEF and Action Against Hunger rely on these formulas to combat childhood mortality in crisis-affected regions. It is a crucial medical intervention that highlights the importance of a phased, careful nutritional approach in treating the most vulnerable patients. The availability of locally-prepared recipes can also increase access to this life-saving intervention.
For additional information on WHO guidelines for treating severe malnutrition, you can refer to the Pocket Book of Hospital Care for Children.
Conclusion
The starter diet F-75 is a specialized medical food for the initial stabilization phase of severe acute malnutrition. It is a carefully engineered formula with low protein, fat, and sodium but high carbohydrates and essential minerals, designed to correct severe metabolic imbalances without overwhelming the patient's compromised body. It is a critical first step in a multi-phase treatment protocol that prepares the child for the subsequent rehabilitation phase and eventual recovery. F-75 must be administered under strict medical supervision and is not a substitute for regular feeding. Its proper application in clinical settings has been instrumental in reducing childhood mortality related to severe malnutrition worldwide.
