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Fetriyuna F, Purwestri RC, Susandy M, Köhler R, Jati IRAP, Wirawan NN, Biesalski HK. Composite Flour from Indonesian Local Food Resources to Develop Cereal/Tuber Nut/Bean-Based Ready-to-Use Supplementary Foods for Prevention and Rehabilitation of Moderate Acute Malnutrition in Children. Foods 2021; 10:foods10123013. [PMID: 34945564 PMCID: PMC8702171 DOI: 10.3390/foods10123013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/07/2021] [Revised: 11/28/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
Undernourishment is a threat to human health. The prevalence of undernourishment remains alarming, especially among children under five years old in many countries, including Indonesia. Nowadays, the handling of undernourishment has shifted to treatment outside the hospital, utilizing local nutrient-rich foods. At the national level, the utilization of local food resources is a part of the promotion of dietary diversification and the bioeconomy. Ready-to-use supplementary food (RUSF) refers to supplementary foods aimed at improving the nutrition of moderate acute malnutrition (MAM) children under five years old. RUSF biscuit recipes were made using local food resources available in Banten province, Indonesia. To optimize the nutritional profile of the developed RUSF, taro/talas banten were mixed with ground-nut/peanut (Arachis hypogaea L.) and mungbean (Vigna radiata) as protein and lipid sources and red rice (Oryza longistaminata) and maize (Zea mays) as carbohydrate sources, and enriched by the local banana Nangka (Musa textilia). Two formulations were selected for the pilot testing, namely the taro-peanut and taro-peanut/mungbean RUSF biscuits, made from taro Banten, cereal, peanut and/or mungbean, and local banana. The RUSF biscuit showed promising results, presenting a high level of acceptance and a macronutrient composition that meets the standards for MAM children. However, the RUSF biscuits should be fortified with micronutrient premix to fulfill the dietary requirement for the MAM children. The results of this study provide further development opportunities.
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Affiliation(s)
- Fetriyuna Fetriyuna
- Institute of Nutritional Science (140a), University of Hohenheim, Garbenstrasse 30, 70599 Stuttgart, Germany; (R.K.); (H.-K.B.); (R.C.P.)
- Department of Food Technology, Faculty of Agro-Industrial Technology, Universitas Padjadjaran, Jln. Raya Bandung-Sumedang Km. 21, Jatinangor, Sumedang 45363, Indonesia;
- Correspondence: or
| | - Ratna Chrismiari Purwestri
- Institute of Nutritional Science (140a), University of Hohenheim, Garbenstrasse 30, 70599 Stuttgart, Germany; (R.K.); (H.-K.B.); (R.C.P.)
- Faculty of Forestry and Wood Sciences, Czech University of Life Sciences Prague, Kamycka 129, 16500 Praha-Suchdol, Czech Republic
| | - May Susandy
- Department of Food Technology, Faculty of Agro-Industrial Technology, Universitas Padjadjaran, Jln. Raya Bandung-Sumedang Km. 21, Jatinangor, Sumedang 45363, Indonesia;
| | - Realm Köhler
- Institute of Nutritional Science (140a), University of Hohenheim, Garbenstrasse 30, 70599 Stuttgart, Germany; (R.K.); (H.-K.B.); (R.C.P.)
| | - Ignasius Radix A. P. Jati
- Department of Food Technology, Widya Mandala Surabaya Catholic University, Jl. Dinoyo 42-44, Surabaya 60265, Indonesia;
| | - Nia Novita Wirawan
- Faculty of Medicine, School of Nutrition, Universitas Brawijaya, Malang 65145, Indonesia;
| | - Hans-Konrad Biesalski
- Institute of Nutritional Science (140a), University of Hohenheim, Garbenstrasse 30, 70599 Stuttgart, Germany; (R.K.); (H.-K.B.); (R.C.P.)
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Suri DJ, Potani I, Singh A, Griswold S, Wong WW, Langlois B, Shen Y, Chui KHK, Rosenberg IH, Webb P, Rogers BL. Body Composition Changes in Children during Treatment for Moderate Acute Malnutrition: Findings from a 4-Arm Cluster-Randomized Trial in Sierra Leone. J Nutr 2021; 151:2043-2050. [PMID: 33880554 PMCID: PMC8245884 DOI: 10.1093/jn/nxab080] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Measures that better describe "healthy" and sustainable recovery during nutritional treatment of children with moderate acute malnutrition (MAM) are needed. OBJECTIVES We compared changes to body composition among children receiving 1 of 4 specialized nutritious food (SNFs) during treatment of MAM and by recovery and relapse outcomes. METHODS The study was nested within a prospective, cluster-randomized, community-based, cost-effectiveness trial assessing 4 SNFs to treat children aged 6-59 mo with MAM [midupper arm circumference (MUAC) ≥11.5 cm and <12.5 cm without bipedal edema] in Sierra Leone. Biweekly SNF rations (1 of 3 fortified-blended foods or a lipid-based nutrient supplement) were given until children recovered (MUAC ≥12.5 cm), or up to 7 rations (∼12 wk). Deuterium dilution was used to estimate fat-free mass (FFM) and fat mass (FM) at enrollment and after 4 wk of treatment to ensure similar treatment exposure among the participants. Another MUAC measurement was performed among recovered children 4 wk after program exit to determine whether recovery was sustained. ANOVA, paired t tests, and linear regression models were used to determine significant differences in changes from baseline to 4 wk. RESULTS Among 312 analyzed participants, mean baseline weight comprised ∼80% FFM; mean weight gained after 4 wk comprised ∼82% FFM. Changes in FM and FFM among 4 SNFs were similar. Children who recovered gained more weight (241%), FFM (179%), and weight-for-height z score (0.44 compared with 0) compared with those who did not recover; sustainers gained 150% more weight. FM gains were positive among recovered children and sustainers, as well as negative among those who did not recover or sustain recovery, but not significantly different. CONCLUSIONS Four SNFs had similar effects on body composition in children after 4 wk of treatment for MAM, showing a healthy pattern of weight gain, the majority being FFM. Differential responses to treatment underscore a need for further research to provide targets for healthy, sustainable recovery. This trial was registered at clinicaltrials.gov as NCT03146897.
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Affiliation(s)
- Devika J Suri
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Isabel Potani
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Akriti Singh
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Stacy Griswold
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - William W Wong
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Breanne Langlois
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Ye Shen
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | | | - Irwin H Rosenberg
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
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Roediger R, Stein H, Callaghan‐Gillespie M, Blackman JK, Kohlmann K, Maleta K, Manary M. Protein quality in ready-to-use supplementary foods for moderate wasting. Matern Child Nutr 2020; 16:e13019. [PMID: 32426949 PMCID: PMC7507576 DOI: 10.1111/mcn.13019] [Citation(s) in RCA: 2] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/26/2022]
Abstract
There are no guidelines for the optimal protein quality of ready-to-supplementary food (RUSF) for moderate acute malnutrition (MAM). This randomized, controlled, double-blinded, clinical effectiveness trial evaluated two RUSFs in the treatment of MAM. Both foods contained greater than 7% dairy protein, but the protein-optimized RUSF had a calculated digestible indispensable amino acid score (DIAAS) of 95%, whereas the control RUSF had a calculated DIAAS of 63%. There were 1,737 rural Malawian children 6-59 months of age treated with 75 kcal/kg/day of either control or protein quality-optimized RUSF for up to 12 weeks. There was no difference in the proportion of children who recovered from MAM between the group that received protein-optimized RUSF (759/860, 88%) and the group that received control RUSF (766/877, 87%, difference 1%, 95% CI, -2.1 to 4.1, p = 0.61). There were no differences in time to recovery or average weight gain; nor were adverse effects reported. Both RUSFs showed indistinguishable clinical outcomes, with recovery rates higher than typically seen in treatment for MAM. The DIAAS of these two RUSFs was measured using a pig model. Unexpectedly, the protein quality of the optimized RUSF was inferior to the control RUSF: DIAAS = 82% for the protein quality optimized RUSF and 96% for control RUSF. The controlled conditions of this trial suggest that in supplementary food products for MAM, protein quality is not an independent predictor of clinical effectiveness.
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Affiliation(s)
- Rebecca Roediger
- Division of Gastroenterology, Department of MedicineWashington UniversitySt. LouisMissouriUSA
| | | | | | | | - Kristin Kohlmann
- Department of PediatricsWashington UniversitySt. LouisMissouriUSA
| | - Kenneth Maleta
- Department of Community Health, College of MedicineUniversity of MalawiBlantyreMalawi
| | - Mark Manary
- Department of PediatricsWashington UniversitySt. LouisMissouriUSA
- Department of Community Health, College of MedicineUniversity of MalawiBlantyreMalawi
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Roberts SB, Franceschini MA, Krauss A, Lin PY, Braima de Sa A, Có R, Taylor S, Brown C, Chen O, Johnson EJ, Pruzensky W, Schlossman N, Balé C, Wu KC(T, Hagan K, Saltzman E, Muentener P. A Pilot Randomized Controlled Trial of a New Supplementary Food Designed to Enhance Cognitive Performance during Prevention and Treatment of Malnutrition in Childhood. Curr Dev Nutr 2017; 1:e000885. [PMID: 29658962 PMCID: PMC5898396 DOI: 10.3945/cdn.117.000885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/11/2017] [Accepted: 10/12/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cognitive impairment associated with childhood malnutrition and stunting is generally considered irreversible. OBJECTIVE The aim was to test a new nutritional supplement for the prevention and treatment of moderate-acute malnutrition (MAM) focused on enhancing cognitive performance. METHODS An 11-wk, village-randomized, controlled pilot trial was conducted in 78 children aged 1-3 or 5-7 y living in villages in Guinea-Bissau. The supplement contained 291 kcal/d for young children and 350 kcal/d for older children and included 5 nutrients and 2 flavan-3-ol-rich ingredients not present in current food-based recommendations for MAM. Local bakers prepared the supplement from a combination of locally sourced items and an imported mix of ingredients, and it was administered by community health workers 5 d/wk. The primary outcome was executive function abilities at 11 wk. Secondary outcomes included additional cognitive measures and changes in z scores for weight (weight-for-age) and height (height-for-age) and hemoglobin concentrations at 11 wk. An index of cerebral blood flow (CBF) was also measured at 11 wk to explore the use of this measurement as a biological index of cognitive impairment. RESULTS There were no significant differences in any outcome between groups at baseline. There was a beneficial effect of random assignment to the supplement group on working memory at 11 wk in children aged 1-3 y (P < 0.05). This difference contrasted with no effect in older children and was not associated with faster growth rate. In addition, CBF correlated with task-switching performance (P < 0.05). CONCLUSIONS These preliminary data suggest that cognitive impairment can be monitored with measurement of CBF. In addition, the findings provide preliminary data that suggest that it may be possible to improve poor cognitive performance in young children through changes in the nutritional formulation of supplementary foods used to prevent and treat MAM. Powered studies of the new supplement formulation are needed. This trial was registered at clinicaltrials.gov as NCT03017209.
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Affiliation(s)
- Susan B Roberts
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Amy Krauss
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Pei-Yi Lin
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA
| | - Augusto Braima de Sa
- International Partnership for Human Development, Leesburg, VA
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | - Raimundo Có
- International Partnership for Human Development, Leesburg, VA
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | - Salima Taylor
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Carrie Brown
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Oliver Chen
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Elizabeth J Johnson
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - William Pruzensky
- International Partnership for Human Development, Leesburg, VA
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | | | - Carlito Balé
- International Partnership for Human Development, Leesburg, VA
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | - Kuan-Cheng (Tony) Wu
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA
| | - Katherine Hagan
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA
| | - Edward Saltzman
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Stobaugh HC, Bollinger LB, Adams SE, Crocker AH, Grise JB, Kennedy JA, Thakwalakwa C, Maleta KM, Dietzen DJ, Manary MJ, Trehan I. Effect of a package of health and nutrition services on sustained recovery in children after moderate acute malnutrition and factors related to sustaining recovery: a cluster-randomized trial. Am J Clin Nutr 2017; 106:657-666. [PMID: 28615258 PMCID: PMC6482975 DOI: 10.3945/ajcn.116.149799] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 05/15/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Children who recover from moderate acute malnutrition (MAM) have high rates of relapse in the year after nutritional recovery. Interventions to decrease these adverse outcomes are needed to maximize the overall effectiveness of supplemental feeding programs (SFPs).Objective: We evaluated the effectiveness of a package of health and nutrition interventions on improving the proportion of children who sustained recovery for 1 y after MAM treatment. We further explored factors related to sustained recovery.Design: We conducted a cluster-randomized clinical effectiveness trial involving rural Malawian children aged 6-62 mo who were enrolled on discharge from an SFP for MAM. We enrolled 718 children at 10 control sites and 769 children at 11 intervention sites. In addition to routine health and nutrition counseling, the intervention group received a package of health and nutrition interventions that consisted of a lipid nutrient supplement, deworming medication, zinc supplementation, a bed net, and malaria chemoprophylaxis. A survival analysis was used to determine the effectiveness of the intervention as well as to identify factors associated with sustained recovery.Results: Of 1383 children who returned for the full 12-mo follow-up period, 407 children (56%) and 347 children (53%) sustained recovery in the intervention and control groups, respectively. There was no significant difference in relapse-free survival curves between the treatment and control groups (P = 0.380; log-rank test). The risk factors for relapse or death after initial recovery were a smaller midupper arm circumference on SFP admission (P = 0.01) and discharge (P < 0.001), a lower weight-for-height z score on discharge (P < 0.01), and the receipt of ready-to-use supplementary food as opposed to ready-to-use therapeutic food during treatment (P < 0.05).Conclusion: The provision of a package of health and nutrition services in addition to traditional SFP treatment has no significant effect on improving sustained recovery in children after treatment of MAM. This trial was registered at clinicaltrials.gov as NCT02351687.
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Affiliation(s)
- Heather C Stobaugh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA,Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Lucy B Bollinger
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Sara E Adams
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Audrey H Crocker
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Jennifer B Grise
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Julie A Kennedy
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | | | | | - Dennis J Dietzen
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Mark J Manary
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO,School of Public Health and Family Medicine,Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Indi Trehan
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO; .,Department of Pediatrics and Child Health, University of Malawi, Blantyre, Malawi.,Partners In Health, Harper, Liberia
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Choudhury N, Bromage S, Alam MA, Shamsir Ahmed A, Munirul Islam M, Iqbal Hossain M, Mahfuz M, Mondal D, Haque R, Ahmed T. Intervention study shows suboptimal growth among children receiving a food supplement for five months in a slum in Bangladesh. Acta Paediatr 2016; 105:e464-73. [PMID: 27415153 DOI: 10.1111/apa.13528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/24/2016] [Accepted: 07/12/2016] [Indexed: 11/28/2022]
Abstract
AIM This study assessed weight and height changes among underweight children who received a locally produced, cereal-based, ready-to-use supplementary food. METHODS We recruited 500 underweight Bangladeshi children aged 6-23 months from a Dhaka slum and individually matched them by sex and neighbourhood with 480 well-nourished controls. The intervention group received the daily food supplement for five months, and both groups received daily micronutrient supplements. Their weight, height, mid-upper-arm circumference and head circumference were measured monthly. RESULTS The children's mean daily weight gain decreased from 1.27 to 0.66 grams per kilogram per day (g/kg/day) in the intervention group and 0.77 to 0.49 g/kg/day in the controls after adjusting for age differences between the two groups from baseline to five months of follow-up. The mean monthly height gain decreased from 1.13 to 1.03 millimetres per metre per month in the intervention children and 1.26 to 1.01 in the controls. The weight gain was highest in the intervention children who were most wasted at baseline and the controls who were least stunted. CONCLUSION The children showed suboptimal growth despite food supplements, highlighting the need for ongoing research to develop inexpensive, locally sourced food supplements to improve the nutrition of underweight children in Bangladesh.
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Affiliation(s)
- Nuzhat Choudhury
- Nutrition and Clinical Services Division; ICDDR,B; Dhaka Bangladesh
| | - Sabri Bromage
- Department of Nutrition; Harvard T.H. Chan School of Public Health; Boston MA USA
| | | | - A.M. Shamsir Ahmed
- Disease Prevention and Control Division; University of Queensland School of Public Health; Herston QLD Australia
| | - M. Munirul Islam
- Nutrition and Clinical Services Division; ICDDR,B; Dhaka Bangladesh
| | - M. Iqbal Hossain
- Nutrition and Clinical Services Division; ICDDR,B; Dhaka Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division; ICDDR,B; Dhaka Bangladesh
| | - Dinesh Mondal
- Nutrition and Clinical Services Division; ICDDR,B; Dhaka Bangladesh
| | - Rashidul Haque
- Nutrition and Clinical Services Division; ICDDR,B; Dhaka Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division; ICDDR,B; Dhaka Bangladesh
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Stobaugh HC, Ryan KN, Kennedy JA, Grise JB, Crocker AH, Thakwalakwa C, Litkowski PE, Maleta KM, Manary MJ, Trehan I. Including whey protein and whey permeate in ready-to-use supplementary food improves recovery rates in children with moderate acute malnutrition: a randomized, double-blind clinical trial. Am J Clin Nutr 2016; 103:926-33. [PMID: 26864368 DOI: 10.3945/ajcn.115.124636] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 12/22/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The utility of dairy ingredients in the supplementary foods used in the treatment of childhood moderate acute malnutrition (MAM) remains unsettled. OBJECTIVE We evaluated the effectiveness of a peanut-based ready-to-use supplementary food (RUSF) with soy protein compared with a novel RUSF containing dairy ingredients in the form of whey permeate and whey protein concentrate in the treatment of children with MAM. DESIGN We conducted a randomized, double-blind clinical effectiveness trial involving rural Malawian and Mozambican children 6-59 mo of age with MAM treated with either soy RUSF or a novel whey RUSF treatment of ~75 kcal · kg(-1) · d(-1) for up to 12 wk. RESULTS The proportion of children that recovered from MAM was significantly higher in the group that received whey RUSF (960 of 1144; 83.9%) than in the group that received soy RUSF (874 of 1086; 80.5%; P < 0.04; risk difference 3.4%, 95% CI: 0.3%, 6.6%). Children who consumed whey RUSF also demonstrated better growth markers, with a higher mean midupper arm circumference (MUAC) at the time of discharge (P < 0.009), greater MUAC gain during the course of treatment (P < 0.003), higher mean weight-for-height z score at discharge (P < 0.008), and greater weight gain (P < 0.05). No significant differences were identified in length gain or time to recovery between the 2 groups. CONCLUSION This study highlights the importance of milk protein in the treatment of MAM, because the use of a novel whey RUSF resulted in higher recovery rates and improved growth than did soy RUSF, although the whey RUSF supplement provided less total protein and energy than the soy RUSF. This study was registered at clinicaltrials.gov as NCT01790048.
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Affiliation(s)
- Heather C Stobaugh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA; Departments of Pediatrics and
| | | | | | | | | | | | | | | | - Mark J Manary
- Departments of Pediatrics and Departments of Community Health and Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Indi Trehan
- Departments of Pediatrics and Paediatrics and Child Health, University of Malawi, Blantyre, Malawi; and
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Trehan I, Banerjee S, Murray E, Ryan KN, Thakwalakwa C, Maleta KM, Manary MJ. Extending supplementary feeding for children younger than 5 years with moderate acute malnutrition leads to lower relapse rates. J Pediatr Gastroenterol Nutr 2015; 60:544-9. [PMID: 25419681 DOI: 10.1097/MPG.0000000000000639] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Children with moderate acute malnutrition (MAM) have a high rate of relapse and death in the year following recovery. In this pilot study, we evaluate the long-term benefits of an extended course of nutritional therapy for children with MAM. METHODS Rural Malawian children 6 to 59 months old with MAM, defined as a weight-for-height z score (WHZ) between -2 and -3, were provided supplementary feeding for a fixed duration of 12 weeks. The children were then studied for 12 months to assess long-term nutritional status, and compared with children initially treated only until they first reached WHZ > -2. RESULTS Compared with children treated until they reached WHZ > -2, children treated for 12 weeks were more likely to remain well nourished (71% vs 63%, P = 0.0015) and maintain more normal anthropometric indices during 12 months of follow-up; there was also a trend towards lower rates of severe acute malnutrition (7% vs 10%, P = 0.067) and death (2% vs 4%, P = 0.082). Regression modeling showed that mid-upper arm circumference and WHZ at the end of supplementary feeding were the most important factors in predicting which children remained well nourished (P < 0.001 for each). CONCLUSIONS The duration of supplementary feeding for children with MAM may not be as important as their anthropometry in terms of remaining well nourished after initial recovery. The presently accepted recovery criteria of WHZ of -2 may be insufficient for ensuring long-term nutritional health; consideration should be given to setting higher recovery criteria.
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