Bandsma RHJ, et al. - Among hospitalized children with severe acute malnutrition (SAM) in Kenya and Malawi, researchers assess a modified F75 formula with substantially reduced carbohydrate content and without lactose vs the currently recommended formulation of F75. Four hundred and eighteen and 425 severely malnourished children were randomized to F75 and modified F75 (mF75), with 516 (61%) enrolled in Kenya and 327 (39%) enrolled in Malawi, respectively. The median stabilization time between randomized groups was 3 days, which was similar. During the stabilization phase, the empirical treatment of severely malnourished hospitalized children with a lactose-free, reduced-carbohydrate milk formula did not improve clinical results. For intestinal absorption, the lactose-free formulae may still exceed the carbohydrate load threshold, which may limit its usefulness in complicated SAM. At admission, age, edema, or HIV status, there was no evidence of effect modification by diarrhea.