title: Changes in plasma phosphate during in-patient treatment of children with severe acute malnutrition: an observational study in Uganda.
abstract: BACKGROUND
  Children treated for severe acute malnutrition (SAM) are at risk of refeeding hypophosphatemia. Therapeutic diets have only recently become fortified with phosphorus to meet United Nations (UN) specifications, but to our knowledge no studies have investigated the effect.
  
  
  OBJECTIVE
  The aim was to assess concentrations and correlates of plasma phosphate (P-phosphate) at admission and during treatment and to identify correlates of changes in P-phosphate.
  
  
  METHODS
  This was a prospective observational study in 6- to 59-mo-old children admitted for treatment of SAM to Mulago Hospital, Uganda. P-phosphate was measured at admission, on the second day of treatment with a therapeutic formula containing 75 kcal/100 mL and 560 mg phosphorus/L (F-75, Nutriset), at the start of the transition to a therapeutic formula containing 100 kcal/100 mL and 579 mg phosphorus/L (F-100; Nutriset), at day 2 of transition, and at discharge.
  
  
  RESULTS
  Among 120 children, mean ± SD P-phosphate at admission was 1.04 ± 0.31 mmol/L and increased by 0.43 (95% CI: 0.35, 0.52) mmol/L during the first 2 d and more slowly toward discharge. Most (79%) children experienced their lowest P-phosphate concentration at admission, and none developed severe hypophosphatemia. P-phosphate was lowest in children with edema and with elevated C-reactive protein, and a lower increase was seen with increasing caretaker-reported severity of illness. Partially or fully replacing F-75 with rice porridge (i.e., a local practice to reduce diarrhea) during the first 2 d of stabilization was associated with a 0.34-mmol/L (95% CI: 0.18, 0.50 mmol/L) lower increase in P-phosphate during the same first 2 d.
  
  
  CONCLUSIONS
  F-75, which complies with UN specifications and provides 73 mg phosphorus · kg(-1) · d(-1) (130 mL · kg(-1) · d(-1)), seems to prevent refeeding hypophosphatemia in children with SAM. Replacing this formula with rice porridge during the first days of treatment to manage diarrhea may have an adverse effect on P-phosphate concentrations. This study was registered at http://www.isrctn.com as ISRCTN55092738.
authors.affiliation: Mwanamugimu Nutrition Unit, Department of Pediatrics, Mulago Hospital, Kampala, Uganda;
authors.forename: Hanifa
authors.identifier: http://orcid.org/0000-0003-1490-3158
authors.initials: H
authors.lastname: Namusoke
authors.affiliation: Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark;
authors.forename: Anne-Louise
authors.initials: AL
authors.lastname: Hother
authors.affiliation: Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark;
authors.forename: Maren Jh
authors.identifier: http://orcid.org/0000-0002-9490-9586
authors.initials: MJ
authors.lastname: Rytter
authors.affiliation: Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark;
authors.forename: Pernille
authors.identifier: http://orcid.org/0000-0003-2769-4666
authors.initials: P
authors.lastname: Kæstel
authors.affiliation: Mwanamugimu Nutrition Unit, Department of Pediatrics, Mulago Hospital, Kampala, Uganda; Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark;
authors.forename: Esther
authors.initials: E
authors.lastname: Babirekere-Iriso
authors.affiliation: Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark;
authors.forename: Christian
authors.initials: C
authors.lastname: Fabiansen
authors.affiliation: Department of Pediatrics and Child Health, College of Public Health and Medical Science, Jimma University, Jimma, Ethiopia; and.
authors.forename: Tsinuel
authors.identifier: http://orcid.org/0000-0002-3538-0061
authors.initials: T
authors.lastname: Girma
authors.affiliation: Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark;
authors.forename: Christian
authors.identifier: http://orcid.org/0000-0002-5095-0624
authors.initials: C
authors.lastname: Ritz
authors.affiliation: Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark;
authors.forename: Kim F
authors.identifier: http://orcid.org/0000-0003-0449-0839
authors.initials: KF
authors.lastname: Michaelsen
authors.affiliation: Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark; Department of International Health, University of Tampere School of Medicine, Tampere, Finland.
authors.forename: André
authors.identifier: http://orcid.org/0000-0001-9390-8541
authors.initials: A
authors.lastname: Briend
authors.affiliation: Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark; hfr@nexs.ku.dk.
authors.forename: Henrik
authors.identifier: http://orcid.org/0000-0002-2848-2940
authors.initials: H
authors.lastname: Friis
mesh_terms: D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000009:adverse effects; D019587:Dietary Supplements; D005260:Female; D005440:Fluid Therapy; D019648:Foods, Specialized / Q000009:adverse effects; D006801:Humans; D017674:Hypophosphatemia / Q000209:etiology / Q000517:prevention & control*; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D010710:Phosphates / Q000097:blood; D010758:Phosphorus / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D055677:Refeeding Syndrome / Q000503:physiopathology / Q000517:prevention & control*; D015532:Rehydration Solutions / Q000627:therapeutic use; D000067011:Severe Acute Malnutrition / Q000097:blood / Q000178:diet therapy* / Q000503:physiopathology / Q000628:therapy; D012720:Severity of Illness Index; D014454:Uganda; D014480:United Nations
chemical_list: D010710:Phosphates; D015532:Rehydration Solutions; D010758:Phosphorus
keywords: Africa; children; diarrhea; hypophosphatemia; phosphorus; refeeding syndrome; rice porridge; severe acute malnutrition; therapeutic feeding