Increased vs. Standard Dose of Iron in Ready-to-Use Therapeutic Foods for the Treatment of Severe Acute Malnutrition in a Community Setting: A Systematic Review and Meta-Analysis

Abstract

The optimal dose of iron in ready-to-use therapeutic foods (RUTF) used to treat uncomplicated severe acute malnutrition in community settings is not well established. The objective of this systematic review was to assess if an increased iron dose in RUTF, compared with the standard iron dose in the World Health Organization (WHO)-recommended peanut-based RUTF, improved outcomes in children aged six months or older. We searched multiple electronic databases and only included randomized controlled trials. We pooled the data in a meta-analysis to obtain relative risk (RR) and reported it with a 95% confidence interval (CI). Three studies, one each from Zambia, the Democratic Republic of Congo, and Malawi, were included. In all studies, the RUTF used in the intervention group was milk-free soya–maize–sorghum-based RUTF. The pooled results showed that, compared to the control group, a high iron content in RUTF may lead to increase in hemoglobin concentration (mean difference 0.33 g/dL, 95% CI: 0.02, 0.64, two studies, certainty of evidence: low) and a decrease in any anemia (RR 0.66, 95% CI: 0.48, 0.91, two studies, certainty of evidence: low), but also decrease recovery rates (RR 0.91, 95% CI: 0.84, 0.99, three studies, certainty of evidence: low) and increase mortality (RR 1.30, 95% CI: 0.87, 1.95, three studies, certainty of evidence: moderate). However, the CIs were imprecise for the latter outcome. Future studies with large sample sizes are needed to confirm the beneficial versus harmful effects of high iron content in RUTF in treating uncomplicated SAM in children aged 6-59 months in community settings.

Effects of prebiotics on microbial diversity and abundance in young children with acute malnutrition: Study protocol for a multi-centered, double-blinded randomized controlled trial

“…Children suffering from SAM are usually treated with RUTF, however, literature indicates that the iron content present in RUTF may not be sufficient to elevate the iron levels to optimal range among them [21]. Considering this and the presence of symptoms of diarrhea, pneumonia, acute gastroenteritis, and acute respiratory infections among SAM children, the present trial aims to evaluate the effect of RUTF+prebiotics on management and gut microbiome diversity of SAM children.…”

“…With persistence iron and B12 deficiency and symptoms of diarrhea, pneumonia, acute gastroenteritis, and acute respiratory infections among SAM children [18], ready-to-use therapeutic food (RUTF) has proven to be a revolutionary rehabilitative therapy for managing the malnutrition among them by promoting weight gain and improving developmental potential [19][20]. However, iron present in standard RUTF may not be sufficient to elevate circulating levels of ferritin into the optimal physiological range as one meta-analysis revealed higher hemoglobin levels and lower rates of anemia among SAM children when treated with high iron content as compared to standard RUTF [21]. The rate of relapse has also been a question among children treated with RUTF.…”