Thiamine content of F‐75 therapeutic milk for complicated severe acute malnutrition: time for a change?

Abstract

Since community-based management of severe acute malnutrition has become the standard of care, the clinical profile of severe acutely malnourished patients admitted to hospitals or inpatient therapeutic feeding centers has changed significantly. These patients are usually very ill and often present with several comorbidities, such as shock, sepsis, and pneumonia. Complicated severe acute malnutrition patients are at risk of thiamine insufficiency, and critically ill patients have higher thiamine requirements. The thiamine content of F-75, the therapeutic milk formula used in the early stabilization phase of refeeding in patients with severe acute malnutrition, seems insufficient. Here, we discuss the need and rationale for a substantial increase in the thiamine content of F-75.

Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs

“…Upon admission to a hospital, these patients often receive several days of a low‐protein 75 kcal/100 mL refeeding milk formula (F75), which provides a possibly insufficient amount of thiamine (0.5–1.7 mg/day depending on the total daily F75 intake). Several experts have recently recommended increasing the thiamine content of this formula to align with therapeutic amounts …”

Thiamine deficiency disorders: a clinical perspective

“…Infants under 6 months of age with SAM do not receive RUTF, F‐75, or F‐100 but only receive breastmilk or specifically diluted F‐100 or F‐75 when regular infant formula is not available to supplement breastfeeding. In view of the high thiamine needs, there have been recent calls for the reformulation of therapeutic foods with increased thiamine content 60 or to treat critically ill SAM patients with pharmacological doses of thiamine (intravenous or oral), according to clinical indications in the early stages of refeeding 61 . For example, recent guidelines from the American Society for Parenteral and Enteral Nutrition recommend 2 mg/kg thiamine, to a maximum of 100–200 mg/day, before feeding or dextrose‐containing fluids are initiated, followed by thiamine supplementation for 5–7 days or longer in high‐risk patients 62 …”

Thiamine fortification strategies in low‐ and middle‐income settings: a review

“… 22 In addition, children with severe acute malnutrition are likely at risk of thiamine deficiency due to increased thiamine needs during critical illness; 23 this is of particular concern during the initial phase of refeeding, with recent calls for the reformulation of therapeutic foods with increased thiamine content. 24 …”

“…Thus, pregnant and lactating women should be a priority for thiamine control and prevention programs, 11,18 as thiamine is thought to be preferentially sequestered by the fetus in utero , 20,21 and the thiamine intake of mothers influences milk thiamine concentrations 22 . In addition, children with severe acute malnutrition are likely at risk of thiamine deficiency due to increased thiamine needs during critical illness; 23 this is of particular concern during the initial phase of refeeding, with recent calls for the reformulation of therapeutic foods with increased thiamine content 24 …”