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Razakamanana MV, Rakotonirainy M, Ramiandrisoa TO. Nutrition policy or price stabilisation policy: which policy is more effective for nutrition outcomes? BMC Nutr 2024; 10:72. [PMID: 38734680 PMCID: PMC11088095 DOI: 10.1186/s40795-024-00882-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/08/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Malnutrition remains a global problem and is increasing with the emergence of the COVID-19 pandemic. In Madagascar, half of the children under five years of age suffer from stunting. However, since 2006, vitamin A supplementation campaigns, deworming and free vaccinations have been implemented within the framework of the Mother and Child Health Week (MCHW) to strengthen the fight against micronutrient deficiencies and reduce mortality. On the other hand, rice, the staple food of the Malagasy population, can provide some of the micronutrients necessary for good nutrition. However, the country's rice production is still insufficient, and the price has been rising steadily in recent years. This has led the government to resort to the policy of stabilizing rice prices through imported rice in 2017 and 2018. The aim of this paper is therefore to analyse the effects of these policies on the prevalence of malnutrition among children under five years of age in Madagascar. Which policy would be more effective: the nutrition policy or the price stabilisation policy? METHODS Data from the Multiple Indicator Cluster Survey conducted by the National Institute of Statistics in 2018 are used, and logistic regressions for the analysis of the effects of nutrition policies on nutrition outcomes are performed. For the effect of price stabilisation policy, panel data on 22 regions of Madagascar from 2016 to 2019 are considered, and a fixed effect model is used. RESULTS We found that the effects of the nutrition policy are not immediately visible. Only participation in the 2016 MCHW contributes to a lower probability of malnutrition occurrence. The odds ratios of the effects of this participation on stunting are 0.69 (p-value: 0.05); on underweight: 0.70 (p-value < 0.01); and on wasting: 0.57 (p-value < 0.01). However, the participation rate remains very low. Then, there is no effect of the rice price stabilization policy on nutrition outcomes (0.00; p-value = 0.11). CONCLUSIONS Price stabilisation policy is not sufficient to fight against malnutrition, due to a lack of food diversification. These results suggest the need for a policy to ensure nutritional intake and to sensitize the population to participate in the MCHW. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Marilys Victoire Razakamanana
- Centre de Recherche pour le Développement (CRD), Université Catholique de Madagascar Ambatoroka, Antananarivo 101, Ambatoroka, BP, 6059, Madagascar.
| | - Miora Rakotonirainy
- Centre de Recherche pour le Développement (CRD), Université Catholique de Madagascar Ambatoroka, Antananarivo 101, Ambatoroka, BP, 6059, Madagascar
| | - Tiarinisaina Olivier Ramiandrisoa
- Centre de Recherche pour le Développement (CRD), Université Catholique de Madagascar Ambatoroka, Antananarivo 101, Ambatoroka, BP, 6059, Madagascar
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Vresk L, Flanagan M, Daniel AI, Potani I, Bourdon C, Spiegel-Feld C, Thind MK, Farooqui A, Ling C, Miraglia E, Hu G, Wen B, Zlotkin S, James P, McGrath M, Bandsma RHJ. Micronutrient status in children aged 6-59 months with severe wasting and/or nutritional edema: implications for nutritional rehabilitation formulations. Nutr Rev 2024:nuad165. [PMID: 38350491 DOI: 10.1093/nutrit/nuad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Undernutrition remains a global struggle and is associated with almost 45% of deaths in children younger than 5 years. Despite advances in management of severe wasting (though less so for nutritional edema), full and sustained recovery remains elusive. Children with severe wasting and/or nutritional edema (also commonly referred to as severe acute malnutrition and part of the umbrella term "severe malnutrition") continue to have a high mortality rate. This suggests a likely multifactorial etiology that may include micronutrient deficiency. Micronutrients are currently provided in therapeutic foods at levels based on expert opinion, with few supportive studies of high quality having been conducted. This narrative review looks at the knowledge base on micronutrient deficiencies in children aged 6-59 months who have severe wasting and/or nutritional edema, in addition to highlighting areas where further research is warranted (See "Future Directions" section).
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Affiliation(s)
- Laura Vresk
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Flanagan
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Allison I Daniel
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isabel Potani
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Celine Bourdon
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carolyn Spiegel-Feld
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mehakpreet K Thind
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amber Farooqui
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catriona Ling
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emiliano Miraglia
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Guanlan Hu
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bijun Wen
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stanley Zlotkin
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Philip James
- Emergency Nutrition Network, Oxford, United Kingdom
| | | | - Robert H J Bandsma
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Chandra J, Kumar P. Anemia in Severe Acute Malnutrition: Ten Steps of Management Need to be Fine-Tuned. Indian J Pediatr 2023; 90:1061-1064. [PMID: 37436578 DOI: 10.1007/s12098-023-04742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Jagdish Chandra
- Department of Pediatrics, PGIMSR and ESIC Model Hospital, Basaidarapur, New Delhi, India.
- B-1007, Sea Show CGHS, Plot 14, Sector 19B, Dwarka, New Delhi, 110075, India.
| | - Praveen Kumar
- Department of Pediatrics, LHMC and KSCH, New Delhi, India
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Nikièma V, Kangas ST, Salpeteur C, Briend A, Talley L, Friis H, Ritz C, Nexo E, McCann A. Vitamin B12 Status before and after Outpatient Treatment of Severe Acute Malnutrition in Children Aged 6-59 Months: A Sub-Study of a Randomized Controlled Trial in Burkina Faso. Nutrients 2023; 15:3496. [PMID: 37630687 PMCID: PMC10458940 DOI: 10.3390/nu15163496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 08/27/2023] Open
Abstract
Severe acute malnutrition (SAM) is treated with ready-to-use therapeutic foods (RUTF) containing a vitamin-mineral premix. Yet little is known about micronutrient status in children with SAM before and after treatment. We aimed to investigate vitamin B12 status in children with uncomplicated SAM, aged 6-59 months in Burkina Faso, before and after treatment with a standard or a reduced dose of RUTF. Blood samples were collected at admission and discharge. Serum B12 was determined with microbiological assay and serum methylmalonic acid (MMA) and total homocysteine (tHcy) were analyzed with gas chromatography-tandem mass spectrometry. B12 status was classified using the combined indicator (3cB12). Among 374 children, the median [interquartile range] age was 11.0 [7.7-16.9] months, and 85.8% were breastfed. Marked or severe B12 deficiency, as judged by 3cB12, decreased from 32% to 9% between admission and discharge (p < 0.05). No differences in B12 status following treatment with either standard (n = 194) or reduced (n = 180) doses of RUTF were observed. Breastfed children showed a lower B12 status (3cB12) than non-breastfed ones (-1.10 vs -0.18, p < 0.001 at admission; -0.44 vs 0.19; p < 0.001 at discharge). In conclusion, treatment of SAM with RUTF improved children's B12 status but did not fully correct B12 deficiency.
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Affiliation(s)
- Victor Nikièma
- Expertise and Advocacy Department, Action Against Hunger (ACF), 93558 Montreuil, France;
| | - Suvi T. Kangas
- Airbel Impact Lab, International Rescue Committee, New York, NY 10168, USA;
| | - Cécile Salpeteur
- Expertise and Advocacy Department, Action Against Hunger (ACF), 93558 Montreuil, France;
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark; (A.B.); (H.F.); (C.R.)
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, 33100 Tampere, Finland
| | - Leisel Talley
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA;
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark; (A.B.); (H.F.); (C.R.)
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark; (A.B.); (H.F.); (C.R.)
| | - Ebba Nexo
- Department of Clinical Biochemistry, Aarhus University Hospital, 8200 Aarhus, Denmark;
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Rachmadewi A, Soekarjo DD, Bait BR, Suryantan J, Noor R, Rah JH, Wieringa FT. Ready-to-Use Therapeutic Foods (RUTFs) Based on Local Recipes Are as Efficacious and Have a Higher Acceptability than a Standard Peanut-Based RUTF: A Randomized Controlled Trial in Indonesia. Nutrients 2023; 15:3166. [PMID: 37513584 PMCID: PMC10386054 DOI: 10.3390/nu15143166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
To strengthen community-based treatment of severe acute malnutrition (SAM) in Indonesia, locally produced ready-to-use therapeutic foods (RUTFs) are needed, but data on their acceptability and effectiveness are lacking. We conducted an individually randomized controlled trial in 302 children (6-59 months old) with uncomplicated SAM receiving 8 weeks of a standard RUTF (CON) or one of four alternative RUTFs produced with locally available ingredients: soybean (SOY), mungbean (MUN1, MUN2) or peanuts (PEA). The main outcomes were weight gain and product acceptability. Children consumed on average 2.2 kg of standard RUTF, but up to 4.5 kg of the local products (MUN2, p < 0.05). Mean weight gain did not differ across the groups (p > 0.05). Controlled for consumption, children receiving either CON or SOY RUTF gained >2 g/kg body weight (BW)/day compared with 1.6 g/kg BW/day in children receiving the other RUTF products (p > 0.05). Overall drop-out was 29.1%, ranging from 21.3% (MUN2) to 38.3% (CON, p > 0.05). Mean time to drop out was 19 days in the CON group, significantly shorter than in the PEA group (33.6 days, p < 0.05). Thus, with no difference in weight gain and better acceptance, the development of locally produced RUTFs in Indonesia is warranted to strengthen the community-based treatment of SAM.
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Affiliation(s)
| | | | | | | | - Rivani Noor
- Directorate of Nutrition and Maternal and Child Health, Ministry of Health, Jakarta 12950, Indonesia
| | - Jee Hyun Rah
- UNICEF Indonesia WTC 2, Jakarta 12920, Indonesia
| | - Frank T Wieringa
- UMR QualiSud, Institut de Recherche pour le Développement (IRD), 34394 Montpellier, France
- Qualisud, University of Montpellier, Avignon University, CIRAD, Institut Agro, IRD, Université de la Réunion, 34394 Montpellier, France
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Kangas ST, Coulibaly IN, Tausanovitch Z, Ouologuem B, Marron B, Radin E, Ritz C, Dembele S, Ouédraogo CT, Bailey J. Post-Recovery Relapse of Children Treated with a Simplified, Combined Nutrition Treatment Protocol in Mali: A Prospective Cohort Study. Nutrients 2023; 15:nu15112636. [PMID: 37299599 DOI: 10.3390/nu15112636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The present study aimed to determine the 6-month incidence of relapse and associated factors among children who recovered from acute malnutrition (AM) following mid-upper arm circumference (MUAC)-based simplified combined treatment using the ComPAS protocol. A prospective cohort of 420 children who had reached a MUAC ≥ 125 mm for two consecutive measures was monitored between December 2020 and October 2021. Children were seen at home fortnightly for 6 months. The overall 6-month cumulative incidence of relapse [95%CI] into MUAC < 125 mm and/or edema was 26.1% [21.7; 30.8] and 1.7% [0.6; 3.6] to MUAC < 115 mm and/or edema. Relapse was similar among children initially admitted to treatment with a MUAC < 115 mm and/or oedema and among those with a MUAC ≥ 115 mm but <125 mm. Relapse was predicted by lower anthropometry both at admission to and discharge from treatment, and a higher number of illness episodes per month of follow-up. Having a vaccination card, using an improved water source, having agriculture as the main source of income, and increases in caregiver workload during follow-up all protected from relapse. Children discharged as recovered from AM remain at risk of relapsing into AM. To achieve reduction in relapse, recovery criteria may need to be revised and post-discharge strategies tested.
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Affiliation(s)
| | | | | | | | | | | | - Christian Ritz
- National Institute of Public Health, Copenhagen, Denmark
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Ingenbleek Y. Revisiting PINI Scoring in Light of Recent Biological Advances. Nutrients 2023; 15:1846. [PMID: 37111065 PMCID: PMC10146499 DOI: 10.3390/nu15081846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
The prognostic inflammatory and nutritional index (PINI) is a simple scoring formula allowing the follow-up of dietary protein restriction and infectious complications affecting critically ill patients hospitalized in medical and surgical wards. The World Health organization (WHO) has recently recommended using the binary CRP (C-reactive protein) and AGP (α1-acid glycoprotein) numerators of the PINI formula in underprivileged inhabitants of developing countries to evaluate their (sub)clinical infectious states making their chronic malnutrition worse. These studies, mainly located in Africa and Asia, demonstrate that children and women enduring the combined effects of infectious burden and (micro)nutrient deprivation (principally retinol and iron) usually manifest persistent refractoriness and slackened recovery throughout dietary rehabilitation. The additive measurement of ALB (albumin) and TTR (transthyretin) composing the denominator of the PINI formula is shown to be helpful in grading the downsizing of lean body mass (LBM), a cornerstone of bodybuilding. The confrontation of these four objective parameters thus allows the quantification of the respective importance of nutritional and inflammatory components of any disease process, taking into account that TTR is the sole plasma protein remaining highly correlated to the fluctuations of LBM. The below review highlights the prevailing roles played by protein nutritional states in the release of plasma retinol to target tissues and to the restoration of iron-deficient anemias.
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Affiliation(s)
- Yves Ingenbleek
- Laboratory of Nutrition, Faculty of Pharmacy, University of Strasbourg, Route du Rhin, 67401 Illkirch-Graffenstaden, France
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Yin J, Niu J, Huo J, Sun J, Huang J, Sun C. Construction and Evaluation of a Novel MAP Immunoassay for 9 Nutrition-and-Health-Related Protein Markers Based on Multiplex Liquid Protein Chip Technique. Nutrients 2023; 15:nu15061522. [PMID: 36986252 PMCID: PMC10059960 DOI: 10.3390/nu15061522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
We attempted to construct and evaluate a novel detection method to realize simultaneous detection based on a multiplex liquid protein chip technique for nine nutrition-and-health-related protein markers to meet the requirement of an accurate, simultaneous and comprehensive analysis of the proteomics of nutrition and health. The lower limits of detection, biological limits of detection and regression equations of serum ferritin (SF), soluble transferrin receptor (sTfR), c-reactive protein (CRP), retinol-binding protein4 (RBP4), apolipoprotein B (ApoB), alpha-fetoprotein (AFP), prealbumin (PA), carcino-embryonic antigen (CEA) and D-Dimmer (D-D) were determined after a series of optimal experiments. Then, the results of the methodological evaluation for this novel method indicated that the accuracies were between 70.12% and 127.07%, the within-run precisions were between 0.85% and 7.31%, the between-run precisions were between 3.53% and 19.07%, the correlation coefficients between this method and other methods were above 0.504 (p < 0.05), and the direct bilirubin (DBIL) of low concentration and the indirect bilirubin (IBIL) of high concentration could not interfere with the detected results of nine indicators. The novel multiplex detection method, which can increase accuracy and improve the ability of comprehensive analysis, can basically meet the requirement of detection and the diagnosis of the proteomics of nutrition and health.
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Affiliation(s)
- Jiyong Yin
- Key Laboratory of Trace Element Nutrition of National Health Commission of the People's Republic of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jiangping Niu
- Key Laboratory of Trace Element Nutrition of National Health Commission of the People's Republic of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Junsheng Huo
- Key Laboratory of Trace Element Nutrition of National Health Commission of the People's Republic of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jing Sun
- Key Laboratory of Trace Element Nutrition of National Health Commission of the People's Republic of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jian Huang
- Key Laboratory of Trace Element Nutrition of National Health Commission of the People's Republic of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Chaoqun Sun
- Key Laboratory of Trace Element Nutrition of National Health Commission of the People's Republic of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Sigh S, Roos N, Chhoun C, Laillou A, Wieringa FT. Ready-to-Use Therapeutic Foods Fail to Improve Vitamin A and Iron Status Meaningfully during Treatment for Severe Acute Malnutrition in 6-59-Month-old Cambodian Children. Nutrients 2023; 15:nu15040905. [PMID: 36839263 PMCID: PMC9961841 DOI: 10.3390/nu15040905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Severe acute malnutrition (SAM) remains a global health concern. Studies on the impact of ready-to-use therapeutic foods (RUTFs) on micronutrient status during SAM treatment are almost nonexistent. The objective was to investigate the impact of RUTFs on the iron and vitamin A status of 6-59-month-old children receiving SAM treatment. Biomarkers of vitamin A status (retinol-binding protein, RBP), iron status (ferritin and soluble transferrin receptor, sTfR), and inflammation (C-reactive protein, CRP, and alpha-1 acid glycoprotein, AGP) were collected at admission and discharge (week 8) during an RUTF effectiveness trial. Vitamin A deficiency was defined as RBP <0.70 µmol/L, low body iron as body iron (BI) <0 mg/kg and deficient iron stores as ferritin <12 µg/L. Data were available for 110 and 75 children at admission and discharge, respectively. There was no significant difference in haemoglobin, ferritin, sTfR, BI or RBP concentrations between admission and discharge. At discharge, BI was 0.2 mg/kg lower, and there was a tendency towards a slightly lower RBP concentration, but the prevalence of vitamin A deficiency was low at admission and discharge (6% and 3%, respectively). The small impact of both RUTFs on improving vitamin A and iron status during SAM treatment calls for further research on the bioavailability of micronutrients to enhance the effectiveness of SAM treatment on micronutrient status.
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Affiliation(s)
- Sanne Sigh
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark
- Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, 186 Preah Norodom Boulevard, Phnom Penh 12101, Cambodia
- Correspondence: ; Tel.: +855-(0)95-201-308
| | - Nanna Roos
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark
| | - Chamnan Chhoun
- Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, 186 Preah Norodom Boulevard, Phnom Penh 12101, Cambodia
| | - Arnaud Laillou
- Nutrition Section, UNICEF West and Central Africa Region, Dakar 29720, Senegal
| | - Frank T. Wieringa
- UMR QualiSud, Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France
- Qualisud, University of Montpellier, Avignon University, CIRAD, Institut Agro, IRD, Université de la Réunion, 34394 Montpellier, France
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Youness RA, Dawoud A, ElTahtawy O, Farag MA. Fat-soluble vitamins: updated review of their role and orchestration in human nutrition throughout life cycle with sex differences. Nutr Metab (Lond) 2022; 19:60. [PMID: 36064551 PMCID: PMC9446875 DOI: 10.1186/s12986-022-00696-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Age and Gender are vital determinants for the micronutrient demands of normal indviduals. Among these micronutrients are vitamins that are required in small amounts for optimum metabolism, homeostasis, and a healthy lifestyle, acting as coenzymes in several biochemical reactions. The majority of previous studies have examined such issues that relates to a specific vitamin or life stage, with the majority merely reporting the effect of either excess or deficiency. Vitamins are classified into water-soluble and fat-soluble components. The fat-soluble vitamins include vitamins (A, D, E, and K). Fat-soluble vitamins were found to have an indisputable role in an array of physiological processes such as immune regulation, vision, bone and mental health. Nonetheless, the fat-soluble vitamins are now considered a prophylactic measurement for a multitude of diseases such as autism, rickets disease, gestational diabetes, and asthma. Herein, in this review, a deep insight into the orchestration of the four different fat-soluble vitamins requirements is presented for the first time across the human life cycle beginning from fertility, pregnancy, adulthood, and senility with an extensive assessment ofthe interactions among them and their underlying mechanistic actions. The influence of sex for each vitamin is also presented at each life stage to highlight the different daily requirements and effects.
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Affiliation(s)
- Rana A Youness
- Molecular Genetics Research Team (MGRT), Pharmaceutical Biology Department, Faculty of Pharmacy and Biotechnology, German University in Cairo, Cairo, Egypt. .,Biology and Biochemistry Department, School of Life and Medical Sciences, University of Hertfordshire Hosted By Global Academic Foundation, Cairo, Egypt.
| | - Alyaa Dawoud
- Molecular Genetics Research Team (MGRT), Pharmaceutical Biology Department, Faculty of Pharmacy and Biotechnology, German University in Cairo, Cairo, Egypt.,Biochemistry Department, Faculty of Pharmacy and Biotechnology, German University in Cairo, Cairo, Egypt
| | - Omar ElTahtawy
- Molecular Genetics Research Team (MGRT), Pharmaceutical Biology Department, Faculty of Pharmacy and Biotechnology, German University in Cairo, Cairo, Egypt
| | - Mohamed A Farag
- Pharmacognosy Department, College of Pharmacy, Cairo University, Kasr El Aini St, Cairo, 11562, Egypt.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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12
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Kangas ST, Salpéteur C, Nikièma V, Ritz C, Friis H, Briend A, Kaestel P. Predictors of time to recovery and non-response during outpatient treatment of severe acute malnutrition. PLoS One 2022; 17:e0267538. [PMID: 35639683 PMCID: PMC9154090 DOI: 10.1371/journal.pone.0267538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background Every year, over 4 million children are treated for severe acute malnutrition with varying program performance. This study sought to explore the predictors of time to recovery from and non-response to outpatient treatment of SAM. Methods Children with weight-for-height z-score (WHZ) <-3 and/or mid-upper arm circumference (MUAC) <115 mm, without medical complications were enrolled in a trial (called MANGO) from outpatient clinics in Burkina Faso. Treatment included a weekly ration of ready-to-use therapeutic foods. Recovery was declared with WHZ ≥-2 and/or MUAC ≥125 mm, for two weeks without illness. Children not recovered by 16 weeks were considered as non-response to treatment. Predictors studied included admission characteristics, morbidity and compliance during treatment and household characteristics. Cox proportional hazard models were fitted and restricted mean time to recovery calculated. Logistic regression was used to analyse non-response to treatment. Results Fifty-five percent of children recovered and mean time to recovery was eight weeks while 13% ended as non-response to treatment. Independent predictors of longer time to recovery or non-response included low age, being admitted with WHZ <-3, no illness nor anaemia at admission, illness episodes during treatment, skipped or missed visits, low maternal age and not practising open defecation. Eighty-four percent of children had at least one and 59% at least two illness episodes during treatment. This increased treatment duration by 1 to 4 weeks. Thirty-five percent of children missed at least one treatment visit. One missed visit predicted 3 weeks longer and two or more missed visits 5 weeks longer treatment duration. Conclusions Both longer time to recovery and higher non-response to treatment seem most strongly associated with illness episodes and missed visits during treatment. This indicates that prevention of illnesses would be key to shortening the treatment duration and that there is a need to seek ways to facilitate adherence.
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Affiliation(s)
- Suvi T. Kangas
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Expertise and Advocacy Department, Action Against Hunger (ACF), Paris, France
- * E-mail:
| | - Cécile Salpéteur
- Expertise and Advocacy Department, Action Against Hunger (ACF), Paris, France
| | - Victor Nikièma
- Nutrition and Health Department, Action Against Hunger (ACF) Mission in Burkina Faso, Paris, France
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Center for Child Health Research, University of Tampere School of Medicine, Tampere University, Tampere, Finland
| | - Pernille Kaestel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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13
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Girma T, James PT, Abdissa A, Luo H, Getu Y, Fantaye Y, Sadler K, Bahwere P. Nutrition status and morbidity of Ethiopian children after recovery from severe acute malnutrition: Prospective matched cohort study. PLoS One 2022; 17:e0264719. [PMID: 35271590 PMCID: PMC8912152 DOI: 10.1371/journal.pone.0264719] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/15/2022] [Indexed: 11/18/2022] Open
Abstract
After recovery, children with severe acute malnutrition (SAM) remain vulnerable to sub-optimal growth and malnutrition relapse. Although there is an increased interest in understanding these problems, data are scarce, and contextual factors can cause variability. We prospectively followed a cohort of Ethiopian children (215 post-SAM cases and 215 non-wasted controls), monthly for one year. The post-SAM cases were: age 6–59 months at admission into the community management of acute malnutrition (CMAM) program and being successfully discharged from CMAM (MUAC>11.0cm, weight gain of 20%, absence of oedema and clinically stable for two consecutive weeks). The controls were apparently healthy children from same village who had no history of an episode of AM and were matched 1:1 to a post-SAM child by age and sex. The primary outcomes were: cumulative incidence of acute malnutrition; growth trajectory; cumulative incidence of reported common morbidities, and cumulative proportion and incidence of deaths. The burden of common morbidities was higher among post-SAM than controls; post-SAM children had more frequent illness episodes (Incidence Rate Ratio of any illness 1.39, 95% CI: 1.14, 1.71; p<0.001). The prevalence of SAM was consistently higher among post-SAM cases than the control group, having a 14 times higher risk of developing SAM (Incidence Rate Ratio: 14.1; 95% CI: 3.5, 122.5; p<0.001). The divergence in weight and growth trajectory remained the same during the study period. Our results advocate for the design of post-discharge interventions that aim to prevent the reoccurrence of acute malnutrition, reduce morbidity and promote catch-up growth. Research is needed to define the appropriate package of post-discharge interventions.
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Affiliation(s)
- Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Philip T. James
- Valid International, Oxford, United Kingdom
- Emergency Nutrition Network, Kidlington, United Kingdom
| | - Alemseged Abdissa
- Department of Laboratory Sciences, Jimma University, Jimma, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Hanqi Luo
- Valid International, Oxford, United Kingdom
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Yesufe Getu
- Valid International, Oxford, United Kingdom
- Department of Physiology, Jimma University, Jimma, Ethiopia
| | - Yilak Fantaye
- Valid International, Oxford, United Kingdom
- Alameda County Public Health Department, Oakland, CA, United States of America
| | | | - Paluku Bahwere
- Valid International, Oxford, United Kingdom
- Center for Epidemiology, Biostatistics, and Clinical Research, School of Public Health, Free University of Brussels, Brussels, Belgium
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14
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Imdad A, François M, Chen FF, Smith A, Tsistinas O, Tanner-Smith E, Das JK, Bhutta ZA. 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. BMJ Open 2022; 12:e057389. [PMID: 35264366 PMCID: PMC8915355 DOI: 10.1136/bmjopen-2021-057389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The current standard of care for children with severe acute malnutrition (SAM) involves using ready-to-use therapeutic food (RUTF) to promote growth; however, the precise formulation to achieve optimal recovery remains unclear. Emerging research suggests that alternative RUTF formulations may be more effective in correcting SAM-related complications such as anaemia and iron deficiency. This systematic review commissioned by the WHO aims to synthesise the most recent research on the iron content in RUTF and related products in the community-based treatment of uncomplicated severe malnutrition in children aged 6 months and older. METHODS AND ANALYSIS We will search multiple electronic databases. We will include randomised controlled trials and non-randomised studies with a control arm. The intervention group will be infants who received RUTF treatments other than the current recommended guidelines set forth by the WHO. The comparison group is children receiving RUTF containing iron at the current WHO-recommended level of 1.9 mg/100 kcal (10-14 mg/100 g). The primary outcomes of interest include blood haemoglobin concentration, any anaemia, severe anaemia, iron-deficiency anaemia, recovery from SAM and any adverse outcomes. We will use meta-analysis to pool findings if sufficient homogeneity exists among included studies. The risk of bias in studies will be evaluated using the Cochrane risk of bias-2. We will use the Grading of Recommendations Assessment, Development, and Evaluation(GRADE) approach to examine the overall certainty of evidence. ETHICS AND DISSEMINATION This is a systematic review and will not involve direct contact with human subjects. The findings of this review will be published in a peer-reviewed journal and will guide the WHO's recommendation on the optimal iron content in RUTFs for the treatment of SAM in children aged 6-59 months.
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Affiliation(s)
- Aamer Imdad
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Melissa François
- College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Fanny F Chen
- College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Abigail Smith
- Library Sciences, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Olivia Tsistinas
- Library Sciences, SUNY Upstate Medical University, Syracuse, New York, USA
| | | | - Jai K Das
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar Ahmed Bhutta
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
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15
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Kawase I, Mori J, Yokoi N. Vitamin A deficiency manifested as conjunctival hyperemia due to a limited food repertoire. Pediatr Int 2022; 64:e14870. [PMID: 35064962 DOI: 10.1111/ped.14870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/14/2021] [Accepted: 05/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Izumi Kawase
- Departments of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jun Mori
- Departments of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Norihiko Yokoi
- Departments of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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16
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Potani I, Spiegel-Feld C, Brixi G, Bendabenda J, Siegfried N, Bandsma RHJ, Briend A, Daniel AI. 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. Adv Nutr 2021; 12:1930-1943. [PMID: 33838044 PMCID: PMC8483958 DOI: 10.1093/advances/nmab027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/19/2021] [Accepted: 02/24/2021] [Indexed: 01/15/2023] Open
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.
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Affiliation(s)
- Isabel Potani
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
| | - Carolyn Spiegel-Feld
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Jaden Bendabenda
- Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Robert H J Bandsma
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| | - André Briend
- Center for Child Health Research, University of Tampere School of Medicine, Tampere, Finland
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Allison I Daniel
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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17
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Nel E, Lombard M. Ready-to-use therapeutic foods for the treatment of malnourished children and infants. Curr Opin Clin Nutr Metab Care 2021; 24:276-280. [PMID: 33741753 DOI: 10.1097/mco.0000000000000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Ready-to-use therapeutic foods (RUTF) allow effective community-based management of severe acute malnutrition (SAM). Current interest focuses on their optimal composition and use. RECENT FINDINGS Studies of alternative RUTF have yielded differing results. Partial soybean, sorghum flour, and whey protein replacement RUTF were inferior to standard RUTF. In contrast, soy-based RUTF was as effective as milk-based RUTF and an alternative RUTF with added oats lead to superior recovery in comparison to standard RUTF.Reducing the dose of RUTF in the later phases of SAM recovery resulted in small reductions in the growth of uncertain clinical significance.Although iron and vitamin A status improve during treatment with standard RUTF, a significant proportion of children remained deficient. Alternative soya, maize, and sorghum-based formulas with no milk protein may improve recovery of iron status compared to standard RUTF.Finally, in children with SAM, plasma essential fatty acids and conversion to long-chain polyunsaturated fatty acids are reduced. Despite the improvement, these parameters remain lower than in normal children after 3 months. SUMMARY New RUTF formulations may provide a cost-effective alternative to standard RUTF. Future research should focus on addressing micronutrient deficiency, lipid metabolism, and long-term recovery.
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Affiliation(s)
- Etienne Nel
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape
| | - Martani Lombard
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa
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18
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N'Diaye DS, Wassonguema B, Nikièma V, Kangas ST, Salpéteur C. Economic evaluation of a reduced dosage of ready-to-use therapeutic foods to treat uncomplicated severe acute malnourished children aged 6-59 months in Burkina Faso. Matern Child Nutr 2021; 17:e13118. [PMID: 33621428 PMCID: PMC8189238 DOI: 10.1111/mcn.13118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/06/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022]
Abstract
Ready‐to‐use therapeutic foods (RUTF) used to treat children with severe acute malnutrition (SAM) are costly, and the prescribed dosage has not been optimized. The MANGO trial, implemented by Action Contre la Faim in Burkina Faso, proved the non‐inferiority of a reduced RUTF dosage in community‐based treatment of uncomplicated SAM. We performed a cost‐minimization analysis to assess the economic impact of transitioning from the standard to the reduced RUTF dose. We used a decision‐analytic model to simulate a cohort of 399 children/arm, aged 6–59 months and receiving SAM treatment. We adopted a societal perspective: direct medical costs (drugs, materials and staff time), non‐medical costs (caregiver expenses) and indirect costs (productivity loss) in 2017 international US dollar were included. Data were collected through interviews with 35 caregivers and 20 informants selected through deliberate sampling and the review trial financial documents. The overall treatment cost for 399 children/arm was $36,550 with the standard and $30,411 with the reduced dose, leading to $6,140 (16.8%) in cost savings ($15.43 saved/child treated). The cost/consultation was $11.6 and $9.6 in the standard and reduced arms, respectively, with RUTF accounting for 56.2% and 47.0% of the total. The savings/child treated was $11.4 in a scenario simulating the Burkinabè routine SAM treatment outside clinical trial settings. The reduced RUTF dose tested in the MANGO trial resulted in significant cost savings for SAM treatment. These results are useful for decision makers to estimate potential economic gains from an optimized SAM treatment protocol in Burkina Faso and similar contexts.
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Affiliation(s)
- Dieynaba S N'Diaye
- Research unit, Expertise & Advocacy Department, Action Contre la Faim, Paris, France
| | - Bibata Wassonguema
- Research unit, Expertise & Advocacy Department, Action Contre la Faim, Paris, France
| | | | - Suvi T Kangas
- Research unit, Expertise & Advocacy Department, Action Contre la Faim, Paris, France.,Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Cécile Salpéteur
- Research unit, Expertise & Advocacy Department, Action Contre la Faim, Paris, France
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19
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Nikièma V, Kangas ST, Salpéteur C, Ouédraogo A, Lachat C, Bassolé NHI, Fogny NF. Adequacy of Nutrient Intakes of Severely and Acutely Malnourished Children Treated with Different Doses of Ready-To-Use Therapeutic Food in Burkina Faso. J Nutr 2021; 151:1008-1017. [PMID: 33571369 PMCID: PMC8030704 DOI: 10.1093/jn/nxaa393] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/09/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Ready-to-use therapeutic foods (RUTF) are designed to cover the daily nutrient requirements of children with severe acute malnutrition (SAM). However, with the transfer of uncomplicated SAM care from the hospital environment to the community level, children will be able to consume complementary and family foods (CFF) in addition to RUTF, and this might decrease the quantity of RUTF needed for recovery. OBJECTIVES Using an individually randomized clinical trial, we investigated the effects of a reduced RUTF dose on the daily energy and macronutrient intakes, the proportion of energy coming from CFF, and the mean probability of adequacy (MPA) of intake in 11 micronutrients of 516 children aged 6-59 mo who were treated for SAM in Burkina Faso. METHODS The data were collected using a single 24-h multipass dietary recall, 1 mo after starting treatment, from December 2016 to August 2018, repeated on a subsample of 66 children. Differences between children receiving the reduced RUTF (intervention arm) and those receiving standard RUTF (control arm) were assessed by linear mixed models. RESULTS Daily energy intake was lower (P < 0.01) in the intervention arm (mean ± SD 1321 ± 339 kcal) than in the control arm (1467 ± 319 kcal). CFF contributed to 40% of the daily energy intake in the intervention and 35% in the control arm. The MPA for 11 micronutrients was 0.89 ± 0.1 in the intervention arm and 0.95 ± 0.07 in the control arm (P = 0.06). CONCLUSIONS Reducing the dose of RUTF during SAM treatment had a negative impact on daily energy intake of the children. Despite this, children covered their recommended energy intake. The energy intake coming from CFF was similar between arms, suggesting that children's feeding practices did not change due to the reduction in RUTF in this context. This trial was registered at the IRSCTN registry as ISRCTN50039021.
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Affiliation(s)
| | - Suvi T Kangas
- Expertise and Advocacy Department, Action contre la Faim, Paris, France
| | - Cécile Salpéteur
- Expertise and Advocacy Department, Action contre la Faim, Paris, France
| | - Abdoulaye Ouédraogo
- Food Security and Livelihoods Department, Action contre la Faim, Ouagadougou, Burkina Faso
| | - Carl Lachat
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Belgium
| | - Nestor H I Bassolé
- Department of Biochemistry and microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
| | - Nadia F Fogny
- School of Nutrition and Food Sciences and Technologies, Faculty of Agronomic Sciences, University of Abomey-Calavi, Benin
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20
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Akomo P, Collins S. Comment on RUTF and correction of anaemia and iron deficiency in severe acute malnutrition. Clin Nutr 2020; 39:2935. [PMID: 32727664 DOI: 10.1016/j.clnu.2020.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Peter Akomo
- Valid Nutrition, Cuibín Farm, Derry Duff, Bantry, Co., Cork, Republic of Ireland.
| | - Steve Collins
- Valid Nutrition, Cuibín Farm, Derry Duff, Bantry, Co., Cork, Republic of Ireland; Valid International, 35 Leopold Street, Oxford, OX4 1TW, UK
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21
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Kangas ST, Briend A, Friis H, Kaestel P. Reply-Comment on RUTF and correction of anaemia and iron deficiency in severe acute malnutrition. Clin Nutr 2020; 39:2936-2937. [PMID: 32788090 DOI: 10.1016/j.clnu.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Suvi T Kangas
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark; Expertise and Advocacy Department, Action Against Hunger (ACF), Paris, France.
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark; Center for Child Health Research, University of Tampere School of Medicine, Tampere University, Tampere, FIN-33014, Finland
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Kaestel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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