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



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).



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.



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.
Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, Frederiksberg C, DK-1958, Denmark. annelouisehother@gmail.com.
Anne-Louise
AL
Hother
Department of Pediatric and Child Health, Jimma University Specialized Hospital, Jimma, Ethiopia.
Tsinuel
T
Girma
Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, Frederiksberg C, DK-1958, Denmark.
Maren J H
MJ
Rytter
Department of Laboratory Sciences and Pathology, Jimma University Specialized Hospital, Jimma, Ethiopia.
Alemseged
A
Abdissa
Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, Frederiksberg C, DK-1958, Denmark.
Christian
C
Ritz
Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, Frederiksberg C, DK-1958, Denmark.
Christian
C
Mølgaard
Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, Frederiksberg C, DK-1958, Denmark.
Kim F
KF
Michaelsen
Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, Frederiksberg C, DK-1958, Denmark.|Department for International Health, University of Tampere, Tampere, Finland.
André
A
Briend
Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, Frederiksberg C, DK-1958, Denmark.
Henrik
H
Friis
Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, Frederiksberg C, DK-1958, Denmark.
Pernille
P
Kæstel
D015415:Biomarkers / Q000097:blood; D002675:Child, Preschool; D005002:Ethiopia; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017674:Hypophosphatemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D007223:Infant; D008274:Magnesium / Q000097:blood*; D008275:Magnesium Deficiency / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D018529:Nutritional Support / Q000009:adverse effects / Q000379:methods; D010710:Phosphates / Q000097:blood*; D011446:Prospective Studies; D000067011:Severe Acute Malnutrition / Q000097:blood / Q000150:complications / Q000178:diet therapy*; D016896:Treatment Outcome
D015415:Biomarkers; D010710:Phosphates; D008274:Magnesium
Hypomagnesemia; Hypophosphatemia; Nutritional rehabilitation; Refeeding syndrome; Severe acute malnutrition; Therapeutic feeding