Abstract

Intestinal pathology in children with complicated severe acute malnutrition (SAM) persists despite standard management. Given the similarity with intestinal pathology in non-IgE mediated gastrointestinal food allergy and Crohn’s disease, we tested whether therapeutic feeds effective in treating these conditions may benefit children with complicated SAM. After initial clinical stabilisation, 95 children aged 6–23 months admitted at Queen Elizabeth Central Hospital, Blantyre, Malawi between January 1st and December 31st, 2016 were allocated randomly to either standard feeds, an elemental feed or a polymeric feed for 14 days. Change in faecal calprotectin as a marker of intestinal inflammation and the primary outcome was similar in each arm: elemental vs. standard 4.1 μg/mg stool/day (95% CI, −29.9, 38.15; P = 0.81) and polymeric vs. standard 10 (−23.96, 43.91; P = 0.56). Biomarkers of intestinal and systemic inflammation and mucosal integrity were highly abnormal in most children at baseline and abnormal values persisted in all three arms. The enteropathy in complicated SAM did not respond to either standard feeds or alternative therapeutic feeds administered for up to 14 days. A better understanding of the pathogenesis of the gut pathology in complicated SAM is an urgent priority to inform the development of improved therapeutic interventions.

Highlights

  • In 2016, severe wasting (weight-for-height Z score (WHZ)

  • Intestinal inflammation in food allergy responds well to exclusion of the offending dietary antigen or, if the offending antigen is not known, a hypoallergenic, elemental feed composed of single amino acids[23]

  • We excluded children with a specific identifiable cause of malnutrition, those participating in another study or those with a sibling admitted with severe acute malnutrition (SAM)

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Summary

Introduction

In 2016, severe wasting (weight-for-height Z score (WHZ)

Methods
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