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use of lactose free formula milk in F-75

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 3 replies. You can also reply via email – be sure to leave the subject unchanged.

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Saba Shahid

Indus hospital

Normal user

24 Mar 2017, 17:46

I am a pediatric consultant managing Malnutrition in inpatient and outpatient setting.We prepare and use F-75 by non-cooking recipe in our hospital, which is causing osmotic diarrhea in children ,recently I have started replacing dried whole milk of the recipe with lactose free infant formula in children having worsened diarrhea.I have found considerable reduction in diarrhea frequency.Does anyone have any experience using lactose free or reduced lactose content F-75 in their practice?

André BRIEND

Frequent user

27 Mar 2017, 06:21

Dear Saba,

Can you clarify what you mean by F-75 prepared with a non cooking recipe ? If you mean a F-75 in which all carbohydrate (except lactose) is provided by sugar, then you have an hyperosmolar feed which may induce diarrhoea in SAM children. The best approach is to go back to the recommended recipe where part of the carbohydrate is provided by cooked rice flour or malto-dextrin.

F-75 has a very low lactose content, about 12 g/L compared with 40g/L for cow milk and about 70g/L for human milk. There is no evidence that this low amount of lactose in F75 is really creating problems. And the lactose content of breast milk is not a problem either.

Infant formula has a protein content much lower than dried skimmed milk. If you replace dried skimmed milk with infant formula in the recipe, you get a diet which will not provide enough protein compared to the needs of SAM children. Either use an unmodified low lactose infant formula or the recommended F-75 reciped.

I hope this helps,

André

Natasha Lelijveld

Normal user

27 Mar 2017, 09:36

Hi, I haven't come across any lactose tolerance issues personally however I happen to see this article the other day from Uganda which might be of interest to you:

http://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-10-31

Natasha

Jessica Bourdaire

Normal user

27 Mar 2017, 13:35

Dear Saba,

If you are using the commercial F75 (isotonic) which contains maltodextrin and low lactose to treat complicated SAM in children, the diarrhoea might not be osmotic but caused by the refeeding. Check for correct dilution and volumes of feeds (adapted to the weight), too large and/or too concentrated amounts can prevent absorption and cause refeeding diarrhoea. Homemade recipes of F75 are likely to have higher osmolarity.

Best,
Jess

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