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Centre for Global Child Health

Lowering lactose and carbs in milk does not help severely malnourished children

New research from The Hospital for Sick Children (SickKids) and the KEMRI-Wellcome Trust Research Programme in Kilifi, Kenya has found that treating hospitalized, severely malnourished children with a lactose-free, reduced-carbohydrate milk formula does not improve clinical outcomes. A formula with an approximately 30 per cent reduction in carbohydrate load without lactose was not more effective than the standard milk formula at reducing the recovery time for children with severe acute malnutrition. The results were published on February 26, 2019 in the open-access journal, PLOS Medicine.

“Our research addresses a long-standing question around how best to feed hospitalized malnourished children, who are among the most vulnerable children globally. The results of this study provide important evidence for clinicians and policy makers treating malnourished around the world.” says Dr. Robert Bandsma, Principal Investigator with the Centre for Global Child Health at The Hospital for Sick Children (SickKids) and a senior author of the paper.

Children with medically complicated severe acute malnutrition have high risk of inpatient mortality. Diarrhea, carbohydrate malabsorption, and refeeding syndrome may contribute to early mortality and delayed recovery. The team of investigators tested whether lactose-free, low-carbohydrate milk would serve to limit these risks, thereby reducing the number of days in the stabilization phase. In a multicentre, double-blind trial in Kenya and Malawi, hospitalized, severely malnourished children with a median age of 16 months were randomized to receive standard formula (418 subjects) or modified formula without lactose and with reduced carbohydrates (425 subjects).

The two groups did not differ significantly in their median time to stabilization based on World Health Organization guidelines, comprising clinical evidence of recovery from acute illness as well as metabolic stabilization. Both groups also showed no significant differences in the incidence of death before stabilization, cumulative days with diarrhea, serious adverse events before stabilization, and serum and stool biochemistry at day three. In addition, biochemical analyses suggested that the lactose-free formula may still exceed a threshold for intestinal absorption, potentially limiting its usefulness in the context of complicated severe acute malnutrition.

The results support the ongoing use of the current milk formulation and suggest that the use of lactose-free formula for severely malnourished children with diarrhea is not adding clinical benefit.