1
|
Vray M, Tondeur L, Hedible BG, Randremanana RV, Manirakiza A, Lazoumar RH, Platen CV, Vargas A, Briend A, Jambou R. Three-arm clinical trial of improved flour targeting intestinal microbiota (MALINEA). Matern Child Nutr 2024:e13649. [PMID: 38599819 DOI: 10.1111/mcn.13649] [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] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024]
Abstract
The main objective of this project was to compare in the field conditions two strategies of re-nutrition of children with moderate acute malnutrition (MAM) aged from 6 to 24 months, targeting the microbiota in comparison with a standard regimen. A three-arm, open-label, pragmatic randomised trial was conducted in four countries (Niger, CAR, Senegal and Madagascar). Children received for 12 weeks either fortified blended flour (FBF control) = arm 1, or FBF + azithromycin (oral suspension of 20 mg/kg/day daily given with a syringe) for the first 3 days at inclusion = arm 2 or mix FBF with inulin/fructo-oligosaccharides (6 g/day if age ≥12 months and 4 g if age <12 months) = arm 3. For each arm, children aged from 6 to 11 months received 100 g x 2 per day of flours and those aged from 12 to 24 months received 100 g × 3 per day of FBF. The primary endpoint was nutritional recovery, defined by reaching a weight-for-height z-score (WHZ) ≥ -1.5 within 12 weeks. Overall, 881 children were randomised (297, 290 and 294 in arm 1, arm 2 and arm 3, respectively). Three hundred and forty-four children were males (39%) and median/mean age were 14.6/14.4 months (SD = 4.9, IQR = 10.5-18.4). At inclusion, the three arms were comparable for all criteria, but differences were observed between countries. Overall, 44% (390/881) of the children recovered at week 12 from MAM, with no significant difference between the three arms (41.4%, 45.5% and 45.9%, in arm 1, arm 2 and arm 3, respectively, p = 0.47). This study did not support the true advantages of adding a prebiotic or antibiotic to flour. When using a threshold of WHZ ≥ -2 as an exploratory endpoint, significant differences were observed between the three arms, with higher success rates in arms with antibiotics or prebiotics compared to the control arm (66.9%, 66.0% and 55.2%, respectively, p = 0.005).
Collapse
Affiliation(s)
- Muriel Vray
- Emerging Diseases Epidemiology Unit, Institut de Pasteur, Université Paris-Cité, Paris, France
| | - Laura Tondeur
- Emerging Diseases Epidemiology Unit, Institut de Pasteur, Université Paris-Cité, Paris, France
| | - Boris G Hedible
- CERPOP UMR1295 Inserm, University of Toulouse, Toulouse, France
| | | | - Alexandre Manirakiza
- Epidemiology and Clinical Research Unit, Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Ramatoulaye Hamidou Lazoumar
- Unit of Epidemiology-Health-Environment-Climate, Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
| | - Cassandre Van Platen
- Center for Translational Science, Clinical Core, Institut Pasteur, Paris, France
| | - Antonio Vargas
- Nutrition and Health Unit, Action Against Hunger, Madrid, Spain
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Ronan Jambou
- Direction Scientifique, Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
| |
Collapse
|
2
|
Vray M, Hedible BG, Adam P, Tondeur L, Manirazika A, Randremanana R, Mainassara H, Briend A, Artaud C, von Platen C, Altmann M, Jambou R. Correction to: A multicenter, randomized controlled comparison of three renutrition strategies for the management of moderate acute malnutrition among children aged from 6 to 24 months (the MALINEA project). Trials 2019; 20:211. [PMID: 30975189 PMCID: PMC6458641 DOI: 10.1186/s13063-019-3339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 11/10/2022] Open
Abstract
After publication of the original article [1], the authors have notified us of an additional acknowledgement they wish to bring for their paper.
Collapse
Affiliation(s)
- Muriel Vray
- Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur Dakar, Dakar, Senegal.,Unité des Epidémies et des Maladies Emergentes, Institut Pasteur, 25 Rue du Dr. Roux, 75015, Paris, France
| | - Boris G Hedible
- Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur Dakar, Dakar, Senegal
| | - Pierrick Adam
- Unité des Epidémies et des Maladies Emergentes, Institut Pasteur, 25 Rue du Dr. Roux, 75015, Paris, France
| | - Laura Tondeur
- Unité des Epidémies et des Maladies Emergentes, Institut Pasteur, 25 Rue du Dr. Roux, 75015, Paris, France
| | - Alexandre Manirazika
- Unité d'Epidémiologie Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Rindra Randremanana
- Unité d'Epidémiologie, Institut Pasteur de Madagascar, BP1274, 101, Antananarivo, Madagascar
| | | | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, DK-1958, Frederiksberg, Denmark.,Tampere Centre for Child Health Research, University of Tampere, Lääkärinkatu 1, 33014, Tampere, Finland
| | - Cecile Artaud
- Centre de recherche Transactionnel, Institut Pasteur, 28 Rue du Dr. Roux, 75015, Paris, France
| | - Cassandre von Platen
- Centre de recherche Transactionnel, Institut Pasteur, 28 Rue du Dr. Roux, 75015, Paris, France
| | - Mathias Altmann
- Action Contre la Faim, 14/16 Boulevard Douaumont - CS 80060, PARIS CEDEX 17, 75854, Paris, France
| | - Ronan Jambou
- Department of Parasites and Vector Insects, Institut Pasteur, 28 Rue du Dr. Roux, 75015, Paris, France.
| |
Collapse
|
3
|
Vray M, Hedible BG, Adam P, Tondeur L, Manirazika A, Randremanana R, Mainassara H, Briend A, Artaud C, von Platen C, Altmann M, Jambou R. A multicenter, randomized controlled comparison of three renutrition strategies for the management of moderate acute malnutrition among children aged from 6 to 24 months (the MALINEA project). Trials 2018; 19:666. [PMID: 30514364 PMCID: PMC6278112 DOI: 10.1186/s13063-018-3027-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/20/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aim of this open-label, randomized controlled trial conducted in four African countries (Madagascar, Niger, Central African Republic, and Senegal) is to compare three strategies of renutrition for moderate acute malnutrition (MAM) in children based on modulation of the gut microbiota with enriched flours alone, enriched flours with prebiotics or enriched flours coupled with antibiotic treatment. METHODS To be included, children aged between 6 months and 2 years are preselected based on mid-upper-arm circumference (MUAC) and are included based on a weight-for-height Z-score (WHZ) between - 3 and - 2 standard deviations (SD). As per current protocols, children receive renutrition treatment for 12 weeks and are assessed weekly to determine improvement. The primary endpoint is recovery, defined by a WHZ ≥ - 1.5 SD after 12 weeks of treatment. Data collected include clinical and socioeconomic characteristics, side effects, compliance and tolerance to interventions. Metagenomic analysis of gut microbiota is conducted at inclusion, 3 months, and 6 months. The cognitive development of children is evaluated in Senegal using only the Developmental Milestones Checklist II (DMC II) questionnaire at inclusion and at 3, 6, and 9 months. The data will be correlated with renutrition efficacy and metagenomic data. DISCUSSION This study will provide new insights for the treatment of MAM, as well as original data on the modulation of gut microbiota during the renutrition process to support (or not) the microbiota hypothesis of malnutrition. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03474276 Last update 28 May 2018.
Collapse
Affiliation(s)
- Muriel Vray
- Unité d’Epidémiologie des Maladies Infectieuses, Institut Pasteur Dakar, Dakar, Senegal
- Unité des Epidémies et des Maladies Emergentes, Institut Pasteur, 25 Rue du Dr. Roux, 75015 Paris, France
| | - Boris G. Hedible
- Unité d’Epidémiologie des Maladies Infectieuses, Institut Pasteur Dakar, Dakar, Senegal
| | - Pierrick Adam
- Unité des Epidémies et des Maladies Emergentes, Institut Pasteur, 25 Rue du Dr. Roux, 75015 Paris, France
| | - Laura Tondeur
- Unité des Epidémies et des Maladies Emergentes, Institut Pasteur, 25 Rue du Dr. Roux, 75015 Paris, France
| | - Alexandre Manirazika
- Unité d’Epidémiologie Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Rindra Randremanana
- Unité d’Epidémiologie, Institut Pasteur de Madagascar, BP1274, 101 Antananarivo, Madagascar
| | | | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, DK-1958 Frederiksberg, Denmark
- Tampere Centre for Child Health Research, University of Tampere, Lääkärinkatu 1, 33014 Tampere, Finland
| | - Cecile Artaud
- Centre de recherche Transactionnel, Institut Pasteur, 28 Rue du Dr. Roux, 75015 Paris, France
| | - Cassandre von Platen
- Centre de recherche Transactionnel, Institut Pasteur, 28 Rue du Dr. Roux, 75015 Paris, France
| | - Mathias Altmann
- Action Contre la Faim, 14/16 Boulevard Douaumont – CS 80060, PARIS CEDEX 17, 75854 Paris, France
| | - Ronan Jambou
- Department of Parasites and Vector Insects, Institut Pasteur, 28 Rue du Dr. Roux, 75015 Paris, France
| |
Collapse
|