Locally-prepared ready-to-use therapeutic food for children with severe acute malnutrition: A controlled trial

Background: Severe acute malnutrition (SAM) remains as one of the major killers of children under five years of age. As per WHO are guidelines, dietary management plays a big role in the longer rehabilitation phase of management of SAM. RUTFs are now being used as a substitute to F-100 diet in the management of SAM around the globe. The objective of the study was to compare the efficacy of locally-prepared ready-to-use therapeutic food (LRUTF) and F-100 diet in promoting weight-gain in children with SAM.Methods: A total of 120 children were included in the study. The control cohort received F-100 while the study cohort received LRUTF diet. Both the groups received a total of 6 feeds per day which included 3 feeds of either LRUTF or F100 and 3 feeds from family pot. Outcome was measured in terms of Rate of weight gain/kg/day, duration of hospital stays and recovery rates.Results: There were 60 subjects in each group. Rate of weight gain was found to be (9.15±3.39 gm/kg/day) in LRUTF group and (6.72±1.05 gm/kg/day) in F-100 group. Significant difference in rate of weight gain was observed in LRUTF group. Duration of hospital stay was lesser in LRUTF group than F-100 group... Recovery rates in LRUTF group were better than F-100 group.Conclusions: LRUTF promotes more rapid weight-gain when compared with F100 in patients with SAM during rehabilitation phase. Duration of hospital stay is lesser in LRUTF group than that of F-100 group.

Download Full-text

Serum iron and serum retinol level of severe acute malnourished children on therapeutic intervention with WHO/UNICEF recommended therapeutic food and home based therapeutic food

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20210125 ◽

2021 ◽

Vol 8 (2) ◽

pp. 337

Author(s):

Bharti Bhandari ◽

Anita Mehta

Keyword(s):

Serum Iron ◽

Severe Acute Malnutrition ◽

Vitamin A Deficiency ◽

Controlled Trial ◽

Acute Malnutrition ◽

P Value ◽

Serum Retinol ◽

Home Based ◽

Significant Difference ◽

Therapeutic Food

Background: The prevalence of anaemia and vitamin A deficiency among children with severe acute malnutrition (SAM) and their correction during nutritional rehabilitation are not well documented. This study assessed serum iron and serum retinol levels, effect of ready-to-use therapeutic foods (RUTF) and home based treatment on levels of serum iron and serum retinol level in SAM children.Methods: This was a simple randomised controlled trial in 6-59 months old children with SAM. Two groups of 70 each were divided, one was given RUTF and other home based food comparable to RUTF. Serum retinol and serum iron were measured on day 1 and 6 weeks of therapy.Results: Home based food was found better in terms of increase in serum iron than RUTF while there was no difference in rise of serum retinol in both the groups. There was no significant difference between day 1 value of serum iron in both the groups as p value was 0.82 but the level of serum iron at 6 weeks has shown significant difference in both the groups as p value was 0.0014 so there was significant increase in serum iron in group B in comparison to group A; the serum retinol value in both the groups has not shown any significant improvement.Conclusions: It was concluded home based food is better in correcting iron deficiency in SAM children as it is cheap, easily available, palatable, and acceptable than RUTF.

Download Full-text

Effectiveness of management of severe acute malnutrition (SAM) through community health workers as compared to a traditional facility-based model: a cluster randomized controlled trial

European Journal of Nutrition ◽

10.1007/s00394-021-02550-y ◽

2021 ◽

Author(s):

Imtiaz Hussain ◽

Atif Habib ◽

Shabina Ariff ◽

Gul Nawaz Khan ◽

Arjumand Rizvi ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Severe Acute Malnutrition ◽

Controlled Trial ◽

Cluster Randomized Controlled Trial ◽

Acute Malnutrition ◽

Randomized Controlled ◽

Cluster Randomized

Download Full-text

Increased risk of acquisition and transmission of ESBL-producing Enterobacteriaceae in malnourished children exposed to amoxicillin

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz487 ◽

2019 ◽

Vol 75 (3) ◽

pp. 709-717 ◽

Cited By ~ 3

Author(s):

Naouale Maataoui ◽

Céline Langendorf ◽

Fatou Berthe ◽

Jumamurat R Bayjanov ◽

Willem van Schaik ◽

...

Keyword(s):

Placebo Group ◽

Severe Acute Malnutrition ◽

Controlled Trial ◽

Acute Malnutrition ◽

Double Blind ◽

Adjusted Risk ◽

Malnourished Children ◽

Nutritional Recovery ◽

Adjusted Risk Ratio ◽

Increased Risk

Abstract Objectives Routine amoxicillin for children with uncomplicated severe acute malnutrition raises concerns of increasing antibiotic resistance. We performed an ancillary study nested within a double-blind, placebo-controlled trial in Niger testing the role of routine 7 day amoxicillin therapy in nutritional recovery of children 6 to 59 months of age with uncomplicated severe acute malnutrition. Methods We screened 472 children for rectal carriage of ESBL-producing Enterobacteriaceae (ESBL-E) as well as their household siblings under 5 years old, at baseline and Week 1 (W1) and Week 4 (W4) after start of therapy, and characterized strains by WGS. ClinicalTrials.gov: NCT01613547. Results Carriage in index children at baseline was similar in the amoxicillin and the placebo groups (33.8% versus 27.9%, P = 0.17). However, acquisition of ESBL-E in index children at W1 was higher in the amoxicillin group than in the placebo group (53.7% versus 32.2%, adjusted risk ratio = 2.29, P = 0.001). Among 209 index and sibling households possibly exposed to ESBL-E transmission, 16 (7.7%) had paired strains differing by ≤10 SNPs, suggesting a high probability of transmission. This was more frequent in households from the amoxicillin group than from the placebo group [11.5% (12/104) versus 3.8% (4/105), P = 0.04]. Conclusions Among children exposed to amoxicillin, ESBL-E colonization was more frequent and the risk of transmission to siblings higher. Routine amoxicillin should be carefully balanced with the risks associated with ESBL-E colonization.

Download Full-text

Predictors of recovery in children aged 6–59 months with uncomplicated severe acute malnutrition: a multicentre study

Public Health Nutrition ◽

10.1017/s1368980020004723 ◽

2020 ◽

pp. 1-9

Author(s):

Sam Marconi David ◽

Preethi N Ragasudha ◽

Sunita Taneja ◽

Sanjana Brahmawar Mohan ◽

Sharad D Iyengar ◽

...

Keyword(s):

Peer Support ◽

Employment Status ◽

Tamil Nadu ◽

Severe Acute Malnutrition ◽

Controlled Trial ◽

Secondary Data ◽

Treatment Phase ◽

Female Child ◽

Hazard Ratio ◽

Acute Malnutrition

Abstract Objective: To identify predictors of recovery in children with uncomplicated severe acute malnutrition (SAM). Design: This is a secondary data analysis from an individual randomised controlled trial, where children with uncomplicated SAM were randomised to three feeding regimens, namely ready-to-use therapeutic food (RUTF) sourced from Compact India, locally prepared RUTF or augmented home-prepared foods, under two age strata (6–17 months and 18–59 months) for 16 weeks or until recovery. Three sets of predictors that could influence recovery, namely child, family and nutritional predictors, were analysed. Setting: Rural and urban slum areas of three states of India, namely Rajasthan, Delhi and Tamil Nadu. Participants: In total, 906 children (age: 6–59 months) were analysed to estimate the adjusted hazard ratio (AHR) using the Cox proportional hazard ratio model to identify various predictors. Results: Being a female child (AHR: 1·269 (1·016, 1·584)), better employment status of the child’s father (AHR: 1·53 (1·197, 1·95)) and residence in a rental house (AHR: 1·485 (1·137, 1·94)) increased the chances of recovery. No hospitalisation (AHR: 1·778 (1·055, 2·997)), no fever, (AHR: 2·748 (2·161, 3·494)) and ≤ 2 episodes of diarrhoea (AHR: 1·579 (1·035, 2·412)) during the treatment phase; availability of community-based peer support to mothers for feeding (AHR: 1·61 (1·237, 2·097)) and a better weight-for-height Z-score (WHZ) at enrolment (AHR: 1·811 (1·297, 2·529)) predicted higher chances of recovery from SAM. Conclusion: The probability of recovery increases in children with better WHZ and with the initiation of treatment for acute illnesses to avoid hospitalisation, availability of peer support and better employment status of the father.

Download Full-text

Treatment of severe acute malnutrition with oat or standard ready-to-use therapeutic food: a triple-blind, randomised controlled clinical trial

Gut ◽

10.1136/gutjnl-2020-320769 ◽

2020 ◽

Vol 69 (12) ◽

pp. 2143-2149 ◽

Cited By ~ 1

Author(s):

David Taylor Hendrixson ◽

Claire Godbout ◽

Alyssa Los ◽

Meghan Callaghan-Gillespie ◽

Melody Mui ◽

...

Keyword(s):

Sierra Leone ◽

Vegetable Oil ◽

Severe Acute Malnutrition ◽

Milk Powder ◽

Acute Malnutrition ◽

Growth Time ◽

Controlled Clinical Trial ◽

Hydrogenated Vegetable Oil ◽

Therapeutic Food ◽

Time To Graduation

ObjectiveWe hypothesised that an alternative RUTF (ready-to-use therapeutic food) made with oats (oat-RUTF) would be non-inferior to standard RUTF (s-RUTF).DesignThis was a randomised, triple-blind, controlled, clinical non-inferiority trial comparing oat-RUTF to s-RUTF in rural Sierra Leone. Children aged 6–59 months with severe acute malnutrition (SAM) were randomised to oat-RUTF or s-RUTF. s-RUTF was composed of milk powder, sugar, peanut paste and vegetable oil, with a hydrogenated vegetable oil additive. Oat-RUTF contained oats and no hydrogenated vegetable oil additives. The primary outcome was graduation, an increase in anthropometric measurements such that the child was not acutely malnourished. Secondary outcomes were rates of growth, time to graduation and presence of adverse events. Intention to treat analyses was used.ResultsOf the 1406 children were enrolled, graduation was attained in 404/721 (56%) children receiving oat-RUTF and 311/685 (45%) receiving s-RUTF (difference 10.6%, 95% CI 5.4% to 15.8%). Death, hospitalisation or remaining with SAM was seen in 87/721 (12%) receiving oat-RUTF and in 125/685 (18%) receiving s-RUTF (difference 6.2%, 95% CI 2.3 to 10.0, p=0.001). Time to graduation was less for children receiving oat RUTF; 3.9±1.8 versus 4.5±1.8 visits, respectively (p<0.001). Rates of weight in the oat-RUTF group were greater than in the s-RUTF group; 3.4±2.7 versus 2.5±2.3 g/kg/d, p<0.001.ConclusionOat-RUTF is superior to s-RUTF in the treatment of SAM in Sierra Leone. We speculate that might be because of beneficial bioactive components or the absence of hydrogenated vegetable oil in oat-RUTF.Trial registration numberNCT03407326.

Download Full-text