Systematic review of the treatment of moderate acute malnutrition using food products

Lelijveld, Natasha; Beedle, Alexandra; Farhikhtah, Arghanoon; Elrayah, Eglal E; Bourdaire, Jessica; Aburto, Nancy

doi:10.1111/mcn.12898

Cited by 33 publications

(35 citation statements)

References 22 publications

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“…Age, months 11 [8][9][10][11][12][13][14][15][16] 12 [8][9][10][11][12][13][14][15][16] 11 [8][9][10][11][12][13][14][15][16] 11 [8][9][10][11][12][13][14][15][16] 11 [8][9][10][11][12][13][14][15][16] 11 [8][9][10][11][12][13][14][15]…”

Section: Sociodemographic Characteristicsunclassified

“…There is still limited knowledge of the effects of nutritional supplements for children with MAM. The majority of studies have focused on the impact of supplements on anthropometric outcomes, but recently, there has been a call for evidence of effects on functional outcomes, including child development, to allow a better understanding of children's ability to thrive following MAM treatment [10,11]. We conducted a randomised factorial trial in Burkina Faso in 2013 to 2014 to assess effects of 2 types of food supplements with varying quality of soy and amount of milk protein for treatment of 6 to 23 months old children with MAM.…”

Section: Introductionmentioning

confidence: 99%

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Impact of food supplements on early child development in children with moderate acute malnutrition: A randomised 2 x 2 x 3 factorial trial in Burkina Faso

et al. 2020

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Background Lipid-based nutrient supplements (LNS) and corn–soy blends (CSBs) with varying soy and milk content are used in treatment of moderate acute malnutrition (MAM). We assessed the impact of these supplements on child development. Methods and findings We conducted a randomised 2 × 2 × 3 factorial trial to assess the effectiveness of 12 weeks’ supplementation with LNS or CSB, with either soy isolate or dehulled soy, and either 0%, 20%, or 50% of protein from milk, on child development among 6–23-month-old children with MAM. Recruitment took place at 5 health centres in Province du Passoré, Burkina Faso between September 2013 and August 2014. The study was fully blinded with respect to soy quality and milk content, while study participants were not blinded with respect to matrix. This analysis presents secondary trial outcomes: Gross motor, fine motor, and language development were assessed using the Malawi Development Assessment Tool (MDAT). Of 1,609 children enrolled, 54.7% were girls, and median age was 11.3 months (interquartile range [IQR] 8.2–16.0). Twelve weeks follow-up was completed by 1,548 (96.2%), and 24 weeks follow-up was completed by 1,503 (93.4%); follow-up was similar between randomised groups. During the study, 4 children died, and 102 children developed severe acute malnutrition (SAM). There was no difference in adverse events between randomised groups. At 12 weeks, the mean MDAT z-scores in the whole cohort had increased by 0.33 (95% CI: 0.28, 0.37), p < 0.001 for gross motor; 0.26 (0.20, 0.31), p < 0.001 for fine motor; and 0.14 (0.09, 0.20), p < 0.001 for language development. Children had larger improvement in language z-scores if receiving supplements with milk (20%: 0.09 [−0.01, 0.19], p = 0.08 and 50%: 0.11 [0.01, 0.21], p = 0.02), although the difference only reached statistical significance for 50% milk. Post hoc analyses suggested that this effect was specific to boys (interaction p = 0.02). The fine motor z-scores were also improved in children receiving milk, but only when 20% milk was added to CSB (0.18 [0.03, 0.33], p = 0.02). Soy isolate over dehulled soy increased language z-scores by 0.07 (−0.01, 0.15), p = 0.10, although not statistically significant. Post hoc analyses suggested that LNS benefited gross motor development among boys more than did CSB (interaction p = 0.04). Differences between supplement groups did not persist at 24 weeks, but MDAT z-scores continued to increase post-supplementation. The lack of an unsupplemented control group limits us from determining the overall effects of nutritional supplementation for children with MAM. Conclusions In this study, we found that child development improved during and after supplementation for treatment of MAM. Milk protein was beneficial for language and fine motor development, while suggested benefits related to soy quality and supplement matrix merit further investigation. Supplement-specific effects were not found post-intervention, but z-scores continued to improve, suggesting a sustained overall effect of supplementation. Trial registration ISRCTN42569496

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Section: Sociodemographic Characteristicsunclassified

Section: Introductionmentioning

confidence: 99%

Impact of food supplements on early child development in children with moderate acute malnutrition: A randomised 2 x 2 x 3 factorial trial in Burkina Faso

et al. 2020

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“…To tackle relapse, it is important to understand why the current criteria might be inappropriate in some cases and whether changes or additional criteria could be used to reduce the relapse risk.Third, the high rate of relapse and the fact that children were most vulnerable shortly after discharge, indicate that some form of follow-up care after OTP treatment is needed to tackle the issue of relapse. Support for MAM should be an integral part of treatment for acute malnutrition, and its absence in Nigeria is an important gap(Lelijveld et al, 2020). Given that lower MUAC at admission is a riskfactor for SAM relapse, integrating MAM treatment into CMAM programmes in Nigeria would catch children earlier in their deterioration in MUAC, thereby potentially lowering the relapse risk.…”

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confidence: 99%

Incidence of severe acute malnutrition after treatment: A prospective matched cohort study in Sokoto, Nigeria

Adegoke

Arif

Bahwere

et al. 2020

Maternal & Child Nutrition

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Severe acute malnutrition (SAM) among children in Nigeria is tackled through the outpatient therapeutic programme (OTP) of the Community‐based Management of Acute Malnutrition (CMAM) programme. CMAM is evidently effective in resolving SAM, but little evidence exists on the remaining risk of SAM relapse for children discharged as cured from the OTP. We aimed to measure and compare the 6‐month incidence of SAM among OTP‐cured and community control children and identify factors associated with SAM relapse. We conducted a prospective matched cohort study that tracked 553 OTP‐cured and 526 control children in Sokoto State, Northern Nigeria. Outcomes and covariates were measured fortnightly in up to 12 home visits. We used multivariate Cox and accelerated failure time models to identify significant risk correlates, where the covariates to be tested for correlation with relapse were selected using domain knowledge and automatic feature selection methods. SAM incidence rates were 52 times higher in the OTP‐cured cohort (0.204/100 child‐days) than in the community control cohort (0.004/100 child‐days). Children with lower mid‐upper arm circumference at OTP admission, with lower height/length‐for‐age z ‐scores, whose household head did not work over the full year, who lived in an area previously affected by environmental shocks, who were female and who had diarrhoea before the visit had a significantly higher relapse risk. Our study shows that OTP‐cured children remain at a significantly excess risk of SAM. To improve long‐term health outcomes of these children, programmes adopting a CMAM approach should strengthen follow‐up care and be integrated with other preventive services.

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“…Initially, efforts should be made to meet these needs with a diverse locally available diet or with food fortification (eg, iodized salt). 52,53 Home fortification of infant foods with micronutrient powders has proved useful in some situations. However, careful monitoring of the effects of iron and folate fortification are recommended because of possible side effects.…”

Section: Resultsmentioning

confidence: 99%

Guidelines for Complementary Feeding of Infants in the Asia Pacific Region: APACPH Public Health Nutrition Group

Binns

Lee

Low

et al. 2020

Asia Pac J Public Health

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Good nutrition in the first “1000 days,” including breastfeeding and appropriate complementary foods, prepares for a healthy childhood and adult life, also contributes to the prevention of the double burden of malnutrition. Exclusive breastfeeding provides all required nutrients until an infant is around 6 months of age when complementary foods are needed. A literature review was undertaken of complementary foods in the Asia Pacific region. The foods being used at present are often of low nutrient density may provide insufficient amounts of some critical nutrients, and generally the variety is limited. Guidelines for complementary feeding are provided to assist in education and in public health planning.

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Systematic review of the treatment of moderate acute malnutrition using food products

Cited by 33 publications

References 22 publications

Impact of food supplements on early child development in children with moderate acute malnutrition: A randomised 2 x 2 x 3 factorial trial in Burkina Faso

Impact of food supplements on early child development in children with moderate acute malnutrition: A randomised 2 x 2 x 3 factorial trial in Burkina Faso

Incidence of severe acute malnutrition after treatment: A prospective matched cohort study in Sokoto, Nigeria

Guidelines for Complementary Feeding of Infants in the Asia Pacific Region: APACPH Public Health Nutrition Group

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