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Therapeutic Feeding: Imported Versus Local Foods

Steve Collins recently drew attention to a situation in Haiti where the only food being used (i.e.,F100) in the treatment of severe malnutrition became unavailable. Health staff subsequently adopted dangerous treatment approaches (i.e., dextrose-saline drips) which resulted in higher mortality rates (>70%) amongst kwashiorkor patients. This led to a network wide debate on the comparative feasibility, appropriateness, and effectiveness of therapeutic milk versus local food products in the treatment of severe malnutrition.

Evidence based consensus indicated that in general, F100 is currently the most nutritious, efficient and cost effective approach to therapeutic feeding in terms of mortality, weight gain, and intestinal recovery, and is therefore appropriate for use in acute relief situations.

While the value of local foods in the 'acute' stage of severe malnutrition remains unclear, recent research has shown encouraging results using local food products in the rehabilitation phase, particularly in 'non emergency'
settings where "ideal" imported diets may be unavailable.

Thus, the reality is, that in the absence of funding to buy 'optimal' foods, there is a need to provide alternative food options to make the best possible use of whatever is available for all levels of dietary management.

To this end, Benjamin Torun (INCAP) and George Fuchs (Centre for Health & Population Research) are setting up a database of locally available and culturally acceptable foods, which have been successfully used to treat patients in different parts of the world.
The information will be available through the NGOnut.

Contributions are welcome !

Note from Prof. Golden

This is an area of active research. In the treatment of severe malnutrition attention needs to be given to all the essential nutrients (there are about 40 of them) and not just energy and protein. In the interim, for those who need to use local produce, my advice is to have a very varied diet with as many different foods being used as possible, rather than simple mixtures of cereal and pulse given monotonously, and to have oil as a major ingredient of every meal to increase the energy density.

In a number of places 'country' salts are traditionally made by burning plants, dissolving and filtering the ash and then evaporating the liquor. These might be a valuable and sustainable source of minerals for such diets - if these are made in your area could you please post a labelled sample to me for analysis.

Prof. Michael H.N.Golden
Dept of Medicine and Therapeutics
Univ of Aberdeen, Foresterhill,
AB9 2ZD. Scotland. U.K.

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Prof. Michael H.N.Golden (1998). Therapeutic Feeding: Imported Versus Local Foods. Field Exchange 4, June 1998. p29. www.ennonline.net/fex/4/food

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