Evaluation of three standard dietary regimes in the treatment of Severe Malnutrition; The “TranSAM study”. An interim analysis.

Vliet, S. van (Sara) (2013) Evaluation of three standard dietary regimes in the treatment of Severe Malnutrition; The “TranSAM study”. An interim analysis. thesis, Medicine.

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Abstract

Malnutrition is still one of the most devastating co-morbidities in young children. Despite following treatment protocols for children suffering from severe acute malnutrition (SAM) based on World Health Organisation (WHO) management guidelines case-fatality rate during rehabilitation, even in specialized centers, remain up to 30%. The rise in co-morbidities such as HIV has dramatically altered the epidemiology, case-presentation, pathophysiology, case-management and outcome of childhood malnutrition. In addition, clinical impression and recent published and unpublished data from the study Unit, MOYO House, at Department of Paediatrics & Child Health, Queen Elisabeth Central Hospital (QECH), Blantyre, Malawi, suggest that case-fatality during rehabilitation of HIV (non-) infected severely malnourished children has been increasing over time and could be related to a specific phase of treatment, namely the Transition Phase. There is data from the laboratory in Groningen, studies in MOYO House, and others that severe malnutrition is associated with a severe impairment in gut function, leading to deficient uptake of nutrients, especially carbohydrates. This impaired function can be associated with watery diarrhoea and can ultimately lead to the child’s demise. There is a lack of data evaluating gut function and optimal nutritional regimen needed during the Transition Phase in rehabilitating severely, especially HIV infected, malnourished children. This study aims to evaluate three different, commonly used and well established WHO/ United Nations International Children's Emergency Fund (UNICEF) (1999; 2009) dietary treatment protocols in severely malnourished children while admitted to MOYO house. The Therapeutic Diets either consists of F75 (WHOs low energy, low protein therapeutic milk) + Ready-to-Use-Therapeutic Food (RUTF), RUTF only, or F100 (WHOs high energy and high protein therapeutic milk). The design was a randomised controlled clinical trial. This report serves as an interim analysis of the first 30 recruitments, looking at stool frequency, stool consistency, frequency of vomiting, electrolyte disturbances, mortality and changes in weight to look at the effect of the three different diets. Hypothesised was that the (too) high carbohydrate content of F75 + RUTF would cause more frequent electrolyte disturbances and would induce more frequent diarrhoea in a still recovering gastro intestinal system compared to RUTF only or F100. The analysed results cannot describe a trend. In addition, no major differences are found between the different diets to break off the study or change the study design. A bigger sample size will be recruited to use for further analyses. These outcomes could possibly provide answers in relation to the effect of the different diets.

Item Type:	Thesis (Thesis)
Supervisor name:	Bandsma, Dr R.H. J.
Supervisor name:	Voskuijl, Dr W.P. and Queen Elisabeth Central Hospital and Malawi
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:46
Last Modified:	25 Jun 2020 10:46
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/748

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