Kim Fleischer Michaelsen, M.D., Dr. Med. Sci.
Professor in Paediatric Nutrition at Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen
Kim F Michaelsen has established the research group: Paediatric and International Nutrition. The group has projects in Denmark, Ethiopia, Cambodia, Kenya and Uganda. The focus of his research include: The effects of breastfeeding and complementary feeding on growth, development and risks of diseases later in life, both in high and low-income countries, early prevention of obesity, and prevention and treatment of MAM and SAM. Studies have included effects of nutrition on linear growth, body composition, microbiota, physical activity and cognitive development. He is advisor to the Danish Health Authority on IYCF and has been temporary advisor and consultant for WHO on several aspects of IYCF.
The role of dairy products in prevention and treatment of undernutrition in low-income countries
Kim F Michaelsen
Dairy protein is a key ingredient in products, such as RUTF and F-100, used for treatment of severe acute malnutrition (SAM). The use of dairy products for treatment of moderate acute malnutrition (MAM), which is also important for preventing SAM is discussed. In a technical note from WHO on treatment of MAM there was no specific recommendation of using dairy products, as long as the protein quality was high. In a Technical Brief from CMAM Forum from 2014 it was stated that animal-source foods are more likely to meet the amino acid and other nutrient needs of recovering children.
There are several reasons why dairy products are effective in preventing and treating undernutrition. The protein quality is high with high levels of important amino acids. Both casein and whey have growth stimulating effects, casein through a stimulating effect on IGF-I and whey through a stimulating effect on insulin, which during this age has an anabolic and growth promoting effect. Furthermore, whey has specific effects on immune and intestinal function. Some of the dairy ingredients used for products for treating and preventing undernutrition contain large amounts of lactose. The effects of lactose in treatment of children with malnutrition have been discussed, because of potential negative effects of lactose intolerance. However, a recent review on the use of lactose in undernourished children concludes that there are potential positive effects: probiotic effects on microbiota, positive effect on mineral absorption and may be growth promoting effects.
A limitation in using high content of milk in products for prevention and treatment of MAM is the price. It is therefore important to identify the lowest content of milk which has a relevant effect and to explore to what degree high protein quality can be obtained by mixing dairy protein with high quality vegetable protein.