1
|
Imdad A, Rogner JL, François M, Ahmed S, Smith A, Tsistinas OJ, Tanner-Smith E, Das JK, Chen FF, Bhutta ZA. 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. Nutrients 2022; 14:nu14153116. [PMID: 35956294 PMCID: PMC9370784 DOI: 10.3390/nu14153116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
The optimal dose of iron in ready-to-use therapeutic foods (RUTF) used to treat uncomplicated severe acute malnutrition (SAM) 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.
Collapse
Affiliation(s)
- Aamer Imdad
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, USA
- Correspondence: ; Tel.: +1-315-464-8444
| | - Jaimie L. Rogner
- Departments of Medicine and Pediatrics, University of Rochester Medical Center, Rochester, NY 13210, USA;
| | - Melissa François
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA; (M.F.); (F.F.C.)
| | - Shehzad Ahmed
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, USA;
| | - Abigail Smith
- Health Science Library, SUNY Upstate Medical University, Syracuse, NY 13210, USA; (A.S.); (O.J.T.)
| | - Olivia J. Tsistinas
- Health Science Library, SUNY Upstate Medical University, Syracuse, NY 13210, USA; (A.S.); (O.J.T.)
| | - Emily Tanner-Smith
- Department of Counseling Psychology and Human Services, College of Education, University of Oregon, Eugene, OR 97403, USA;
| | - Jai K. Das
- Department of Pediatrics and Child Health and Institute of Global Health and Development, Aga Khan University, Karachi 74800, Pakistan;
| | - Fanny F. Chen
- College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA; (M.F.); (F.F.C.)
| | - Zulfiqar Ahmed Bhutta
- Department of Global Child Health, Hospital for SickKids, Toronto, ON M5G 0A4, Canada;
- Center for Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| |
Collapse
|