Ready-to-Use Therapeutic Food (RUTF) Containing Low or No Dairy Compared to Standard RUTF for Children with Severe Acute Malnutrition: A Systematic Review and Meta-Analysis

Abstract

Ready-to-use therapeutic food (RUTF) containing less dairy may be a lower-cost treatment option for severe acute malnutrition (SAM). The objective was to understand the effectiveness of RUTF containing alternative sources of protein (nondairy), or <50% of protein from dairy products, compared with standard RUTF in children with SAM. The Cochrane Library, MEDLINE, Embase, CINAHL, and Web of Science were searched using terms relating to RUTF. Studies were eligible if they included children with SAM and evaluated RUTF with <50% of protein from dairy products compared with standard RUTF. Meta-analysis and meta-regression were completed to assess the effectiveness of intervention RUTF on a range of child outcomes. The quality of the evidence across outcomes was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. A total of 5868 studies were identified, of which 8 articles of 6 studies met the inclusion criteria evaluating 7 different intervention RUTF recipes. Nondairy or lower-dairy RUTF showed less weight gain (standardized mean difference: −0.20; 95% CI: −0.26, −0.15; P < 0.001), lower recovery (relative risk ratio: 0.93; 95% CI: 0.87, 1.00; P = 0.046), and lower weight-for-age z scores (WAZ) near program discharge (mean difference: −0.10; 95% CI: −0.20, 0.0; P = 0.047). Mortality, time to recovery, default (consecutive absences from outpatient therapeutic feeding program visits), nonresponse, and other anthropometric measures did not differ between groups. The certainty of evidence was high for weight gain and ranged from very low to moderate for other outcomes. RUTF with lower protein from dairy or dairy-free RUTF may not be as effective as standard RUTF for treatment of children with SAM based on weight gain, recovery, and WAZ evaluated using meta-analysis, although further research is required to explore the potential of alternative formulations. This review was registered at https://www.crd.york.ac.uk/prospero/ as CRD42020160762.

Ready to use therapeutic food (RUTF) for outpatient-based nutritional rehabilitation of severe acute malnutrition in children aged 6-59 months.

“…The recovery rate was 66 patients ( 70.2 %) .This was in agree with Potani I etal 11 (77.8%) but lower than Irena AH etal 12 (81.9%), and Bahwere P etal 13 The mean of MUAC was ( 12.7±1.07) cm, same as in Hossain M etal 18 study. There was a significant relationship between inpatient care (10 ) patients who are not included in statistical analysis and low MUAC (<11.5 cm) with P value (0.02) .This is in consistent with WHO guideline that revealed Children with a MUAC less than 115 mm have a highly elevated risk of morbidity and death compared to those who are above 19 .…”

The Effects of Moringa oleifera Leaves on Complete Blood Count, Renal and Liver Functions as Potential Therapy for Malnutrition

“…However, it is expensive and it takes a long time to reach affected areas. 3,4 In folklore medicine, many herbs are used to prevent and treat malnutrition and many other conditions e.g., snakebite and tumor. Among…”

Optimal iron content in ready-to-use therapeutic foods for the treatment of severe acute malnutrition in the community settings: a protocol for the systematic review and meta-analysis

“…Open access to optimise the composition and balance of macronutrients and micronutrients. [9][10][11] SAM involves deficits of several key macronutrients and micronutrients, with studies showing higher rates of anaemia in children suffering from malnutrition. [12][13][14] The prevalence of anaemia in severely acutely malnourished children ranges from 40% to 90%, and about half of the anaemia is attributed to iron deficiency.…”

“…The current standard of care for children with uncomplicated SAM involves using ready-to-use therapeutic food (RUTF) to promote growth7; however, the precise formulation to achieve optimal recovery remains unclear 6 8. There are ongoing efforts to improve RUTF to optimise the composition and balance of macronutrients and micronutrients 9–11…”