The treatment for malnutrition, especially severe acute malnutrition (SAM) in children, is a carefully phased process overseen by healthcare professionals. It begins with correcting life-threatening issues, followed by a gradual nutritional recovery. This approach ensures that the body can safely process nutrients without suffering from metabolic shock, also known as refeeding syndrome. The specific diet varies based on the patient's age and severity of their condition, but generally follows a two-stage process: stabilization and rehabilitation.
The Stabilization Phase: Initial Care
The initial phase of treating severe malnutrition focuses on stabilizing the patient's condition and addressing immediate medical issues without overwhelming their delicate metabolic system. For children, this usually takes place in a hospital setting and involves specialized therapeutic milks.
F-75 Therapeutic Milk
In the stabilization phase, the standard diet is a low-protein, low-lactose milk-based formula known as F-75. The key characteristics of F-75 include:
- Low Energy: Providing approximately 75 kcal per 100 ml, it prevents the metabolic overload that can trigger refeeding syndrome.
- High Carbohydrates: The high sugar content helps correct hypoglycemia, a common and dangerous complication in malnourished individuals.
- Controlled Electrolytes: It contains carefully measured levels of potassium and magnesium to correct deficiencies without causing harmful shifts.
- No Added Iron: Iron supplementation is avoided in this initial stage as it can exacerbate existing infections.
Feeds are given frequently, often every two to three hours, day and night, in small, carefully measured amounts. Nasogastric tube feeding may be used for patients who are too weak to consume enough orally.
Managing Related Conditions
Beyond just the feed, the stabilization phase also involves managing associated complications, which can include:
- Dehydration: Treated with a special low-sodium oral rehydration solution called ReSoMal, which is better suited for malnourished individuals than standard solutions.
- Electrolyte Imbalance: Extra potassium and magnesium are added to the feed to correct critical deficiencies.
- Micronutrient Deficiencies: Initial supplementation with high doses of Vitamin A, zinc, and other multivitamins is common, with iron added later in the recovery process.
The Rehabilitation Phase: Catch-up Growth
Once the patient is stabilized and their appetite returns, they can move to the rehabilitation phase, where the goal is to promote rapid, catch-up weight gain. The dietary strategy shifts from low-energy to high-energy, high-protein foods.
F-100 and RUTFs
For inpatient treatment, the F-75 formula is gradually replaced with F-100, a high-energy milk formula providing approximately 100 kcal per 100 ml. However, in many settings, liquid F-100 has been replaced by Ready-to-Use Therapeutic Foods (RUTFs).
Key features of RUTFs include:
- High Nutrient Density: RUTFs are lipid-based pastes (like Plumpy'Nut) that pack high-quality protein, energy, and micronutrients into a small volume.
- No Preparation Needed: They are pre-packaged and ready to eat, reducing the risk of contamination and making them suitable for home-based treatment of uncomplicated SAM.
- Microbe Resistant: Their low moisture content provides a long shelf-life without refrigeration.
- Complete Nutrition: They contain all necessary vitamins and minerals, including iron, which can now be safely introduced.
Comparison of Stabilization vs. Rehabilitation Diet
| Feature | Stabilization Phase Diet (e.g., F-75) | Rehabilitation Phase Diet (e.g., RUTF/F-100) |
|---|---|---|
| Primary Goal | Metabolic stabilization, correction of electrolyte imbalance, and management of infection. | Rapid weight gain and restoring nutritional stores. |
| Energy Content | Low (~75 kcal/100ml) to avoid refeeding syndrome. | High (~100-200 kcal/kg/day) to support catch-up growth. |
| Protein Content | Low (1-1.5 g/kg/day). | High (4-6 g/kg/day). |
| Feeding Frequency | Frequent, small feeds (every 2-3 hours). | Larger, less frequent feeds (every 4 hours or ad libitum). |
| Electrolyte Focus | Correcting potassium and magnesium deficiencies. | Monitoring balance; already included in formula. |
| Iron Supplementation | Withheld to avoid worsening infections. | Included in formula or added once appetite returns. |
| Common Delivery | Nasogastric tube or cup/spoon feeding in a facility. | Oral consumption, often at home with caregiver supervision. |
Adult Malnutrition Treatment
For adults, treatment follows similar principles but with different dietary products and approaches. Dietary interventions may involve:
- Fortified Foods: Regular food items with extra nutrients added.
- Nutritional Supplements: High-energy, high-protein drinks and bars.
- Specialized Feeding: In severe cases, nasogastric tube feeding or parenteral nutrition (intravenous feeding) is used.
- Tailored Plans: A dietitian creates a personalized diet plan based on the individual's needs and underlying health conditions.
Conclusion
The diet given in malnutrition treatment is not a single meal but a structured, phased process tailored to the patient's metabolic state and severity of illness. The initial stabilization phase uses carefully designed low-energy formulas like F-75 to prevent complications, while the subsequent rehabilitation phase employs nutrient-dense products like RUTFs or F-100 to promote rapid recovery and weight gain. Continuous monitoring and expert guidance are essential throughout this process to ensure a safe and successful return to health. For further information on global guidelines for managing malnutrition, consult resources like the World Health Organization (WHO).
