Pilot study launched in Malawi to address severe acute malnutrition.

News article 16 Mar 2016
Professor Stephen Allen

LSTM’s Professor Stephen Allen has begun a pilot study in Malawi to measure the impact of specialist foods on the treatment of severe acute malnutrition (SAM) in young children.

Professor Allen is principal investigator on the study, which began in January and aims to recruit 120 children between six months and two years old. Funded by an award via the Joint Global Health Trials scheme from the MRC, Wellcome Trust and DFID, research will take place in partnership with the Malawi-Liverpool-Wellcome Trust Clinical Research Centre and collaborators in the Netherlands and Canada. Children admitted to the Moyo nutrition ward of the Queen Elizabeth Central Hospital in Blantyre diagnosed with SAM will be recruited.

While great strides have been taken to reduce deaths in children under the age of five in the last 40 years, with numbers reduced by more than half, progress in relation to malnutrition is not as impressive. SAM is most prominent in low-income countries, and undernutrition is thought to be an underlying contributor in up to 45% of all deaths in that age group. Cases of SAM have inflammation of the gut that breaks the healthy structures down which in turn leads to impaired food digestion and nutrient absorption as well as probable increases in secondary infections, including sepsis due to bacteria crossing the damaged mucosa.

The gut inflammation is not dissimilar to that seen in high-income countries as a result of food intolerance or inflammatory conditions, yet these conditions are treated very differently, with the emphasis being on reducing inflammation, where the approach to SAM is nutritional rehabilitation. Professor Allen explained: “Ordinarily the treatment for SAM would rely on high energy feeds, focussed on providing calorific nutrition and micronutrients, but this does not address the inflammation. We are hoping that by treating children suffering from SAM with hypoallergenic and anti-inflammatory feeds given for other forms of gut inflammation, we can increase the ability of the gut to function better, digesting and absorbing nutrients more effectively, as well as providing better protection against life-threatening infections.”

Throughout 2016, children admitted to the study will be randomised to receive either standard feeds or specialist therapeutic feeds and followed up for two weeks. The main outcome is reduced gut inflammation measured using a point of care test and laboratory tests at the end of the trial. Professor Allen continued: “We are hoping that if we can show a beneficial effect within our relatively small cohort of children, that we can expand our research and look at a large scale study with an aim to improve outcomes in children affected by this clinical syndrome in low income settings.”