New knowledge about the bioactive properties of milk has shifted understanding of what drives recovery in malnourished children – and one of the leading researchers in the field believes that severe childhood malnutrition could become a far rarer phenomenon in the years ahead. So writes the Danish Dairy Board.
American paediatrician Mark Manary, professor at Washington University in St. Louis, has spent decades researching childhood malnutrition in Africa, supported in part by the Danish Dairy Research Foundation. The Danish Dairy Board recently published an interview with him about his research and its findings.
A central contribution from Manary is the development of home-based treatment using ready-to-use therapeutic food (RUTF) – typically a peanut-based paste supplemented with milk powder, oil, and elevated levels of vitamins and minerals.
Mortality rates fell markedly once the treatment was introduced. Manary describes the progression himself:
“When we started, mortality dropped significantly. It had originally been around 33 per cent. With the new approach we brought it down to around 7 per cent, and when we also introduced routine antibiotic treatment, it fell further to approximately 4 per cent.”
At the same time, the proportion of children making a full recovery rose from around 50 per cent under hospital treatment to 95 per cent with home-based RUTF.
Milk’s role extends beyond protein
A significant strand of the research concerns understanding precisely why milk performs so well in treatment. Manary’s argument is that milk does not merely supply protein and energy, but triggers biological responses in the body – including via peptides formed during digestion, which appear to regulate how nutrients are used in rebuilding tissue such as the brain and muscles. This makes milk difficult to replace with other ingredients, even where the nutritional content is comparable.
Fat composition has proved particularly important for brain recovery. When Manary adjusted the fat profile of the therapeutic food – with a focus on omega-3 fatty acids, among other things – he observed improvements in children’s cognitive development equivalent to 6 to 15 IQ points. He is currently investigating specific types of milk fat in a study in Sierra Leone, with a focus on brain recovery.
Halved since 2000
Despite the continuing need for research, Manary takes an optimistic view of the broader trajectory. According to him, the number of severely malnourished children worldwide has halved since the turn of the millennium – including in conflict-affected areas – owing to the spread of safety nets and treatment options.
In Ghana, he is also examining the effect of skimmed milk in school feeding programmes and has observed cognitive improvements in children compared with those receiving the national school meals programme. The results of a larger study, which also looks at attendance and school dropout rates, are awaited, according to the Danish Dairy Board.
By Maja Løvstrup
Photo: Mejeri.dk
