Mwanamugimu Nutrition Unit, Department of Paediatrics, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda.
Department of Nutrition, Exercise and Sports, University of Copenhagen, -1958, Frederiksberg C, DK, Denmark.
Nutr J. 2017 Aug 30;16(1):52. doi: 10.1186/s12937-017-0276-z.
World Health Organization now recommends the transition from F-75 to ready-to-use therapeutic foods (RUTF) in the management of severe acute malnutrition (SAM). We described the transition from F-75 to RUTF and identified correlates of failed transition.
We conducted an observational study among children aged 6-59 months treated for SAM at Mulago hospital, Kampala, Uganda. Therapeutic feeding during transition phase was provided by first offering half of the energy requirements from RUTF and the other half from F-75 and then increasing gradually to RUTF as only energy source. The child was considered to have successfully transitioned to RUTF if child was able to gradually consume up to 135 kcal/kg/day of RUTF in the transition phase on first attempt. Failed transition to RUTF included children who failed the acceptance test or those who had progressively reduced RUTF intake during the subsequent days. Failure also included those who developed profuse diarrhoea or vomiting when RUTF was ingested.
Among 341 of 400 children that reached the transition period, 65% successfully transitioned from F-75 to RUTF on first attempt while 35% failed. The median (IQR) duration of the transition period was 4 (3-8) days. The age of the child, mid-upper arm circumference, weight-for-height z-score and weight at transition negatively predicted failure. Each month increase in age reflected a 4% lower likelihood of failure (OR 0.96 (95% CI 0.93; 0.99). Children with HIV (OR 2.73, 95% CI 1.27; 5.85) and those rated as severely ill by caregiver (OR 1.16, 95% CI: 1.02; 1.32) were more likely to fail. At the beginning of the rehabilitation phase, the majority (95%) of the children eventually accepted RUTF while only 5% completed rehabilitation in hospital on F-100.
Transition from F-75 to RUTF for hospitalized children with SAM by gradual increase of RUTF was possible on first attempt in 65% of cases. Younger children, severely wasted, HIV infected and those with severe illness as rated by the caregiver were more likely to fail to transit from F-75 to RUTF on first attempt.
世界卫生组织建议在严重急性营养不良（SAM）的治疗中，将 F-75 转换为即食治疗食品（RUTF）。我们描述了从 F-75 到 RUTF 的转换，并确定了转换失败的相关因素。
我们在乌干达坎帕拉的穆拉戈医院对 6-59 个月大的 SAM 患儿进行了一项观察性研究。在过渡阶段，通过首先提供 RUTF 提供一半的能量需求，另一半由 F-75 提供，然后逐渐增加到仅使用 RUTF 作为能量来源来提供治疗性喂养。如果患儿在首次尝试时能够逐渐摄入 135kcal/kg/天的 RUTF，则认为患儿成功过渡到 RUTF。RUTF 转换失败包括未能通过接受测试的患儿，或在随后几天逐渐减少 RUTF 摄入量的患儿。当摄入 RUTF 时出现大量腹泻或呕吐的患儿也被认为转换失败。
在 400 名达到过渡阶段的儿童中，有 341 名（65%）首次尝试时成功从 F-75 过渡到 RUTF，而 35%失败。过渡阶段的中位（IQR）持续时间为 4（3-8）天。儿童年龄、上臂中部周长、体重与身高的 z 评分和过渡时的体重与失败呈负相关。年龄每月增加 1 岁，失败的可能性降低 4%（OR 0.96（95%CI 0.93；0.99）。HIV 阳性的儿童（OR 2.73，95%CI 1.27；5.85）和被照顾者评定为病重的儿童（OR 1.16，95%CI：1.02；1.32）更有可能失败。在康复阶段开始时，大多数（95%）患儿最终接受了 RUTF，而只有 5%的患儿在医院接受 F-100 完成康复。
通过逐渐增加 RUTF，对住院 SAM 患儿从 F-75 过渡到 RUTF，65%的患儿首次尝试即可成功。年龄较小、严重消瘦、感染 HIV 以及照顾者评定病重的患儿，首次尝试从 F-75 过渡到 RUTF 的可能性较低。
