Journal Article

Serum phosphate and magnesium in children recovering from severe acute undernutrition in Ethiopia: an observational study

Michaelsen, Kim F., Rytter, Maren J. H., Briend, André, Hother, Anne-Louise, Mølgaard, Christian, Friis, Henrik, Kæstel, Pernille, Girma, Tsinuel, Ritz, Christian, Abdissa, Alemseged

2016

Overview

Background Children with severe acute malnutrition (SAM) have increased requirements for phosphorus and magnesium during recovery. If requirements are not met, the children may develop refeeding hypophosphatemia and hypomagnesemia. However, little is known about the effect of current therapeutic diets (F-75 and F-100) on serum phosphate (S-phosphate) and magnesium (S-magnesium) in children with SAM. Methods Prospective observational study, with measurements of S-phosphate and S-magnesium at admission, prior to rehabilitation phase and at discharge in children aged 6–59 months admitted with SAM to Jimma Hospital, Ethiopia. Due to shortage of F-75, 25 (35 %) children were stabilized with diluted F-100 (75 kcal/100 ml). Results Of 72 children enrolled, the mean age was 32 ± 14 months, and edema was present in 50 (69 %). At admission, mean S-phosphate was 0.92 ± 0.34 mmol/L, which was low compared to normal values, but increased to 1.38 ± 0.28 mmol/L at discharge, after on average 16 days. Mean S-magnesium, at admission, was 0.95 ± 0.23 mmol/L, and increased to 1.13 ± 0.17 mmol/L at discharge. At discharge, 18 (51 %) children had S-phosphate below the normal range, and 3 (9 %) had S-phosphate above. Most children (83 %) had S-magnesium above normal range for children. Both S-phosphate and S-magnesium at admission were positively associated with serum albumin (S-albumin), but not with anthropometric characteristics or co-diagnoses. Using diluted F-100 for stabilization was not associated with lower S-phosphate or S-magnesium. Conclusion Hypophosphatemia was common among children with SAM at admission, and still subnormal in about half of the children at discharge. This could be problematic for further recovery as phosphorus is needed for catch-up growth and local diets are likely to be low in bioavailable phosphorus. The high S-magnesium levels at discharge does not support that magnesium should be a limiting nutrient for growth in the F-100 diet. Although diluted F-100 (75 kcal/100 mL) is not designed for stabilizing children with SAM, it did not seem to cause lower S-phosphate than in children fed F-75.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Albumin / Biomarkers - blood / Carbohydrates / Care and treatment / Child, Preschool / Children / Children & youth / diet / Edema / Ethiopia / Female / Follow-Up Studies / Health aspects / Humans / Hypophosphatemia / Hypophosphatemia - blood / Hypophosphatemia - diagnosis / Hypophosphatemia - etiology / Hypophosphatemia - prevention & control / Infant / Internal Medicine / Magnesium - blood / Magnesium Deficiency - blood / Magnesium Deficiency - diagnosis / Magnesium Deficiency - etiology / Magnesium Deficiency - prevention & control / Male / Malnutrition / Medicine / Medicine & Public Health / Nutrition / Nutritional Support - adverse effects / Nutritional Support - methods / Pediatrics / Phosphates / Phosphates - blood / Phosphorus content / physical health and endocrinology / Prospective Studies / Proteins / Recipes / Rehabilitation / Research Article / Risk factors / Severe Acute Malnutrition - blood / Severe Acute Malnutrition - complications / Severe Acute Malnutrition - diet therapy / Treatment Outcome