Date: Wed, 4 Jun 1997 15:13:17 +0100

From: sakatamsterdam.msf.org (Saskia V.D. KAM)

Subject: recovery in adults

Dear NGO-NUTS,

Field staff working in feeding centres in DUAR, South Sudan, asked me the following: Why is the recovery rate in adults so much lower then in children? This statement cannot be proved scientifically: we don't agree yet on proper indicators for different levels of malnutrition in adults.

But the simple observation is that severely malnourished children, once they are on the right way, improve rapidly. In contrast the improvement in adults is at a much lower speed: In children it is a question of weeks for adults a question of months when they appear to be 'normal' again. The adutls had no TB, AIDS or Kala-Azar.

Any explanations?

Saskia van der Kam

Médecins sans Frontières Holland, Amsterdam

Subject: recovery rate in Adults

Date: Wed, 4 Jun 1997 16:49:48 +0100 (BST)

From: "Michael H.N. Golden" <m.goldenatabdn.ac.uk>

The data that I have from ACF confirms the slow rate of weight gain in adults treated in Therapeutic Feeding Centres:

there is the possibility that the slow rate of weight gain is because of body compositional or metabolic differences, however, I do not believe this to be the real explaination.

In Jamaica when I insisted that the adults took the same diet as the children (high energy milk with minerals and vitamins), they achieved rates of weight gain that were similar. However, I did experience initial trouble in persuading adults to take such a diet exclusively.

In the TFCs that I have inspected it is quite clear that the diet taken by the older people and that of the children is quite different. The children will take the bulk of their food as therapeutic milk whereas the adults take mainly family-plate and CSB. We know that when children are fed the same diet that the adults now take they have rates of weight gain that are also around 5g/kg/d.

The development of a diet that is based upon F100 formula and yet is acceptable to adults (and can also be used for outpatient management of children) is part of our "new product development program" - I am confident that when we have the correct product we will achieve the same recovery rates in adults as in children. In the mean time I suggest that the teams try to persuade the adults to take exactly the same formulae as the children - they require less energy for maintainance, but will require the same increment for growth (about 5 kcal above maintenance/gm of weight gain)

Best wishes,

Prof. Michael H.N.Golden