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Treatment of Preg/Lact women with F100/RUTF?

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 2 replies. You can also reply via email – be sure to leave the subject unchanged.

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Hatty Barthorp

Global Nut Advisor / GOAL

Normal user

2 Mar 2009, 08:19

Could I please have some advice on the recommended treatment for severely malnourished P/L women. I am currently working with our Zimbabwe team and have read in the national 'Guidelines for Management of Acute MN through CTC' (currently under review) that the admission criteria for P/L women with SMN is MUAC <185mm. However, there is no subsequent specific reference to their appropriate treatment. Health facilities will have access to therapeutic milks/foods including F75,F100 & PN, but not supplementary feeding products (fortified blended cereals or oil). As such, could I have some guidance on whether or not there has been any published/reviewed info' on feeding P/L women with F100/RUTFs, and indeed whether the Vit A content would be considered too high in terms poss' teratogenic effects to the foetus (esp' in trimester 3)? Thank you.

Marie McGrath

ENN

Forum moderator

4 Mar 2009, 19:32

Dear Hatty,
I put your question to Zita Weise Prinzo and Andre Briend at WHO and they sent me this reply, which I am posting word for word (and thanks to them both for this):

For the treatment of severely malnourished pregnant and lactating women, we suggest to follow the standard treatment for adults as mentioned in the WHO manual "Management of severe malnutrition: a manual for physicians and other senior health workers (pg 37):

http://www.who.int/nutrition/publications/severemalnutrition/9241545119/en/index.html

Possible tetrogenetic effects of high doses of vitamin A can be a problem early in pregnancy, and would, therefore also be a concern for lactating women who may become pregnant. The current recommendation is for women who are or who might become pregnant to limit their total daily vitamin A intake to a maximum of 3000mg RE (10'000IU) to minimize risk of fetal toxicity. See pg 33 of document Vitamin and Mineral Requirements in Human Nutrition:

http://whqlibdoc.who.int/publications/2004/9241546123.pdf

We did a quick calculation based on amounts of vitamin A in F75 and F100 and volume of therapeutic milk recommended daily for the treatment of malnourished adults (initial phase of treatment). Since the recommended intake of therapeutic milk is given per kg body weight, we did the calculations for women weighing 40 kg and 50 kg. The amount of vitamin A in F75 recommended for a severely malnourished woman who is 50 kg reaches the upper recommended limit of 10'000 IU. Amounts of vitamin A present in F100 and RUTF are on the higher range of what is considered as safe (if total calorie intake is from F100 or RUTF alone). The recommendation would, therefore, be for malnourished pregnant and lactating women to diversify their diets during rehabilitation and include a product such as RUTF only as a supplement.

Hope this clarifies some of the points raised. Just for your information, there are plans to revise the upper limits of vitamin A some time in the near future.

Hatty Barthorp

Global Nut Advisor / GOAL

Normal user

6 Mar 2009, 16:20

Excellent - thank you very much for the rapid response Zita and Andre, Marie also for forwarding on the question. I will share this info' and your recommendations with UNICEF Zimbabwe with whom the question was raised. Thnx

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