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Preparation of Therapeutic Feeds

This question was posted the Management of wasting/acute malnutrition forum area and has 6 replies.

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Anonymous_A_W_40

Nutritionist/ M40Re Analytics

Normal user

8 Aug 2022, 09:25

Hello, Can Dilute F100 be made from locally available products when the commercial F100 is not available?

Paul

Action Against Hunger UK

Technical expert

9 Aug 2022, 12:19

Hi Anonymous,

Hypothetically yes. Practically I would urge extreme caution. As a first step you should contact your local authorities to liaise with UNICEF on supplying the appropriate commercial formulation. Home made recipes have a relatively high osmolarity compared to commercial formulas.

Please read a reply to a similar post from Professor Michale Golden. It is important to note the potential clinical consequences and the skilled staff needed to manage the child.

https://www.en-net.org/question/75.aspx

 Professor Golden writes:

"First, F100 cannot be converted to F75, the proportions of the ingredients are quite different. Second, for both F100 and F75 the home-made recipies are MADE UP TO one litre of multiples thereoff. The comercial preparations not the same they are ADDED TO 2 Litres of water. This difference is often not appreciated. When I designed F100 and F75 and then wrote the WHO 1999 manual I stiputated the final volume to be 1000ml. However, in the field it was found to be quite difficult to see the final volume because of the froth (foam) on top that formed during mixing - so there was a change so that the powder was added to a fixed amount of water. Third, the commercial preparation of F75 is very difficult to emulate with home made recipies. The correct formula uses 35g of cereal powder and 70g of sugar. The problem with this formulation is that it becomes quite viscous and is difficult to put down an NG tube. For this reason one of the subesquent advisors to WHO suggested using 100g of sugar instead of the cereal powder. The problem now is that the formulation is hyperosmolar and frequently provokes an osmotic diarrhoea (we had about 12 deaths in Somalia due to this problem when the local staff started to use sugar instead of the cereal powder). If this osmotic diarrhoea is misdiagnosed as infective diarrhoea and treated with resomal then the children get an overload of sodium and go into heart failure. For this reason the formulation using sugar alone is dangerous unless all the staff clearly understand the reason and can correctly differentiate osmotic diarrhoea (no or trivial weight loss) from infective diarrhoea (weight loss if to be treated with rehydration fluids). For these reasons we strongly advocate for the use of the commercial preparation of F75 - relatively small amounts are needed. F75 was designed for the severe cases with liver dysfunction, sepsis, intestinal problems - and particularly for those with kwash. If there are limited supplies of the commercial formulation then, whilst more are being secured, they can be reserved for this type of child who will require NG tube feeding. The children who are not so severely ill can indeed be managed with diluted F100. The problem being that such changes in the protocol to suit pipeline breaks can cause confusion amongst the staff."

WHO provide recipes for various formulations here:

https://apps.who.int/iris/bitstream/handle/10665/205172/B0003.pdf?sequence=1&isAllowed=y

Other recipes are here: 

https://motherchildnutrition.org/malnutrition-management/info/feeding-formulas-f75-f100.html

I hope this helps,

Paul

Chantal Autotte Bouchard

Health Advisor

Normal user

9 Aug 2022, 14:17

Thanks a lot Anonymus for the question and Paul for the answer. This is interesting as some country may have - even with UNICEF in place - some shortage this year due to the conflict and complications. This may as well impact f75 which can complicate well the management case...

Anonymous_A_W_40

Nutritionist/ M40Re Analytics

Normal user

9 Aug 2022, 19:21

@ Paul, Thank you for the response very informative.

Currently there has been a shortage of commercial therapeutic feeds where I am. Thus for management of SAM cases we have to prepare the feeds from locally available products cautiously, However we have a challenge on preparing DILUTED F100 for the under 6 months SAM children because we don't have the recipe unlike F75 and F100 that is well documented on the IMAM guidelines. 

Anonymous_A_W_40

Nutritionist/ M40Re Analytics

Normal user

9 Aug 2022, 19:24

@ Chantal Autotte Bouchard, Thanks for the response.

Yes actually we are facing shortage of commercial therepeutic feeds, so we have to prepare them for continuity of care.

Dr. M Asef Ghyasi

Senior nutrition manager

Normal user

11 Aug 2022, 10:09

Dear all , please find the formula for making F100 and F75 from local available products , I remember in Afghanistan we were using these formula , when for some time we did not had , commercial F100 or F75 . 

F75 and F 100 milk preparation guide reference Afghanistan Nutrition Standard Operation procedure book 2015

If you have kitchen/cooking facility and the ingredients, you can make the F75 recipes as follow:

Type of milk

Content

Quantity for F75

 

 Dry milk without oil

Dry milk without lipid

25 mg

 

sugar

70  mg

 

Flour of cereals

30   mg

 

Vegetable oil

30 mg

 

CMV Complex mineral and Vitamins

20 ml

 

Water  total 1000 cc

water1000 ml

 

Dry full milk

Dry full milk

35 mg

 

sugar

70  mg

 

Flour of cereals

35  mg

 

Vegetable oil

20 mg

 

CMV Complex mineral and Vitamins

20 ml

 

Water  total 1000 cc

water1000 ml

 

Fresh cow full /whole milk 

Fresh cow full /whole milk

300 ml

 

sugar

70  mg

 

Flour of cereals

35  mg

 

Vegetable oil

20 mg

 

CMV Complex mineral and Vitamins

20 ml

 

Water  total 1000 cc

water1000 ml

 

If cereals flour is not available or cooking / kitchen facility is not available , You can use one of the following recipes for F75

Type of milk

Content

Quantity for F75

Quantity for F100

 Dry milk without oil

Dry milk without lipid

25 gr

80 gr

sugar

100 gr

50 gr

Vegetable oil

30 gr

60 gr

CMV Complex mineral and Vitamins

20 ml

20 ml

Water  total 1000 cc

water  1000 CC

water  1000 CC

Dry full milk

Dry full milk

35 g

110 gr

sugar

100  gr

50 gr

Vegetable oil

20 ml

30 gr

CMV Complex mineral and Vitamins

20 ml

20 ml

Water  total 1000 cc

water1000 ml

water1000 ml

Fresh cow full /whole milk 

Fresh cow full /whole milk

300 ml

880 ml

sugar

100 gr

75 gr

Vegetable oil

20 gr

20 gr

CMV Complex mineral and Vitamins

20 ml

20 ml

Water  total 1000 cc

water1000 ml

water1000 ml

Note: adding water is very important recipe to recipe, the total amount should be 1000 ml, if you are using a measuring utensils is the best, hygiene is very important during the preparation and when you are keeping it for hours.

Anonymous_A_W_40

Nutritionist/ M40Re Analytics

Normal user

11 Aug 2022, 18:26

@ Dr. M Asef Ghyasi. Thanks for your response.

Did you by any chance make F100 Dilute?

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