scholarly journals Changes in Body Composition Using Deuterium Dilution Technique Among Young Children Receiving Specialized Nutritious Foods for Moderate Acute Malnutrition in Sierra Leone (P10-141-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Devika Suri ◽  
Isabel Potani ◽  
Akriti Singh ◽  
Stacy Griswold ◽  
William Wong ◽  
...  
Keyword(s):  
Body Composition ◽  
Sierra Leone ◽  
Fat Mass ◽  
Disease Risk ◽  
Statistical Significance ◽  
Humanitarian Assistance ◽  
Acute Malnutrition ◽  
Dilution Technique ◽  
Deuterium Dilution ◽  
Moderate Acute Malnutrition

Abstract Objectives To determine differential changes in children's body composition—fat-free mass (FFM) and fat mass (FM)—after 4 weeks of treatment for moderate acute malnutrition (MAM) with one of 4 four specialized nutritious foods (SNFs). Methods This sub-study was nested within a larger cluster-randomized trial comparing the cost-effectiveness of 4 isocaloric SNFs in treating MAM among children 6–59 months in Pujehun District, Sierra Leone: Corn-Soy Blend Plus w/oil (CSB + w/oil), Super Cereal Plus w/amylase (SC + A), Corn-Soy-Whey Blend w/oil (CSWB w/oil) and Ready-to-use-Supplementary Food (RUSF). Children with mid-upper arm circumference (MUAC) ≥11.5 cm and <12.5 cm with no clinical complications were enrolled and received an SNF ration bi-weekly until they reached MUAC ≥12.5 cm or up to 12 weeks. Body composition was assessed using the deuterium dilution technique at program enrollment and after 4 weeks of treatment. Changes in weight, FM, FFM and %FFM overall and by study arm were calculated; statistical significance was determined using t-tests and ANOVA (unadjusted). Results Among 336 subjects at enrollment, mean ± SD age was 11.8 ± 6.5 mos, weight was 6.5 ± 0.9 kg, FM was 1.3 ± 0.5 kg, FFM was 5.2 ± 0.9 kg, and %FFM was 80.4 ± 7.3. After 4 weeks of treatment, mean ± SD change in weight was 0.44 ± 0.39 kg (P < 0.001), FM was 0.09 ± 0.60 kg (P = 0.005), FFM was 0.35 ± 0.56 (P < 0.001), and %FFM was 0.003 ± 8.5 (NS). Overall, weight gain consisted on average of 20.9% FM and 79.8% FFM. By study arm, mean ± SD changes in FM and FFM respectively, were: 0.12 ± 0.53 kg and 0.32 ± 0.49 kg in CSB + w/oil; 0.13 ± 0.67 kg and 0.34 ± 0.64 kg in SC + A; 0.08 ± 0.65 kg and 0.36 ± 0.57 kg in CSWB w/oil; 0.02 ± 0.49 kg and 0.39 ± 0.5 kg in RUSF. These changes were not significantly different across study arms. Conclusions Over 4 weeks of treatment for MAM, children gained roughly 80% lean mass relative to 20% fat mass. This body composition is consistent with predicted sustainability of recovery from MAM and healthier long-term disease risk. Differential effects on body composition by type of SNF were not detected after 4 weeks of treatment in this study. Funding Sources The Office of Food for Peace, Bureau for Democracy, Conflict, and Humanitarian Assistance, U.S. Agency for International Development.

scholarly journals Association between admission criteria and body composition among young children with moderate acute malnutrition, a cross-sectional study from Burkina Faso

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Christian Fabiansen ◽  
Bernardette Cichon ◽  
Charles W. Yaméogo ◽  
Ann-Sophie Iuel-Brockdorf ◽  
Kevin P. Q. Phelan ◽  
...  
Keyword(s):  
Body Composition ◽  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
Admission Criteria ◽  
Sectional Study ◽  
Cross Sectional ◽  
Low Weight ◽  
Deuterium Dilution ◽  
Moderate Acute Malnutrition ◽  
Mid Upper Arm Circumference

Abstract Children with moderate acute malnutrition (MAM) are treated based on low weight-for-length z-score (WLZ), low mid-upper arm circumference (MUAC) or both. This study aimed to assess associations of admission criteria and body composition (BC), to improve treatment of MAM. We undertook a cross-sectional study among 6–23 months old Burkinabe children with MAM. Fat-free (FFM) and fat mass (FM) were determined by deuterium dilution and expressed as FFM (FFMI) and FM index (FMI). Of 1,489 children, 439 (29.5%) were recruited by low MUAC only (MUAC-O), 734 (49.3%) by low WLZ and low MUAC (WLZ-MUAC) and 316 (21.2%) by low WLZ only (WLZ-O). Thus, 1,173 (78.8%) were recruited by low MUAC, with or without low WLZ (ALL-MUAC). After adjustments, WLZ-O had 89 g (95% confidence interval (CI) 5; 172) lower FFM compared to MUAC-O. Similarly, WLZ-O had 0.89 kg/m2 (95% CI 0.77; 1.01) lower FFMI compared to MUAC-O, whereas there was no difference for FMI. However, boys included by WLZ-O compared to MUAC-O had 0.21 kg/m2 (95% CI 0.05; 0.38) higher FMI. In contrast, girls included by WLZ-O had 0.17 (95% CI 0.01; 0.33) kg/m2 lower FMI compared to MUAC-O (interaction, p = 0.002). We found that different criteria for admission into MAM treatment programmes select children with differences in BC, especially FFMI. Trial registration: ISRCTN42569496.

scholarly journals Comparative Effectiveness of Four Specialized Nutritious Food Products for Treatment of Moderate Acute Malnutrition in Sierra Leone (P10-140-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Breanne Langlois ◽  
Stacy Griswold ◽  
Devika Suri ◽  
Ye Shen ◽  
Kenneth Chui ◽  
...  
Keyword(s):  
International Development ◽  
Graduation Rates ◽  
Sierra Leone ◽  
Severe Acute Malnutrition ◽  
Cluster Randomized Trial ◽  
Humanitarian Assistance ◽  
Acute Malnutrition ◽  
Mixed Effect ◽  
Feeding Program ◽  
Moderate Acute Malnutrition

Abstract Objectives This study compared the effectiveness of 4 specialized nutritious foods (SNFs) used for the treatment of moderate acute malnutrition (MAM) in children <5 years of age in Pujehun District, Sierra Leone. Methods This was a cluster-randomized trial operating through a supplementary feeding program (SFP) providing SNFs for treatment of MAM. Three study foods were fortified blended foods – Super Cereal Plus w/amylase (SC + A), Corn-soy Blend Plus w/oil (CSB + w/oil), and Corn-soy-whey Blend w/oil (CSWB w/oil) – and one was a lipid-based Ready to Use Supplementary Food (RUSF). From 4/2017 to 11/2018, children with MAM, defined as mid-upper arm circumference (MUAC) ≥11.5 cm and <12.5 cm without bipedal edema, were enrolled at participating health clinics and received rations bi-weekly until they reached an outcome or for up to 12 weeks. A stratified randomization technique was used to select 28 sites and randomize them into 7 per arm based on pre-determined criteria. During the study, an 8th site was added to the CSWB w/oil arm due to low enrollment. The primary outcome was graduation from SFP defined as MUAC ≥12.5 cm within the 12-week treatment period. Mixed-effect regression assessed whether there were differences in graduation rates among children treated with one of the 4 SNFs. Results A total of 2683 children were enrolled out of a planned sample size of ∼5000. Overall: 63% graduated from MAM, 19% developed severe acute malnutrition (SAM), 7% defaulted (missed 3 visits in a row), 1% died, and 10% reached no outcome within 12 weeks. Twenty-five % were transferred into the study from SAM treatment. By study arm, graduation rates were: 62% in CSWB w/oil, 65% in SC + A, 64% in CSB + w/oil, 62% in RUSF. In an unadjusted model, statistically significant differences in graduation rates between the arms were not detected. Data analysis is ongoing to determine if this finding is maintained in adjusted models. Conclusions The 4 foods performed comparably in treating MAM in unadjusted analysis. Decision-making by donors, governments, and programmers on which food to program should also be based on cost-effectiveness analysis. Funding Sources Supported by the Office of Food for Peace, Bureau for Democracy, Conflict, and Humanitarian Assistance, U.S. Agency for International Development.

scholarly journals Cost and Cost-Effectiveness of Four Specialized Nutritious Foods for Treatment of Moderate Acute Malnutrition in Sierra Leone (P10-142-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Ye Shen ◽  
Stacy Griswold ◽  
Breanne Langlois ◽  
Devika Suri ◽  
Stephen Vosti ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
International Development ◽  
Sierra Leone ◽  
Graduation Rate ◽  
Humanitarian Assistance ◽  
Acute Malnutrition ◽  
Small Scale ◽  
Activity Based Costing ◽  
Mixed Effect ◽  
Moderate Acute Malnutrition

Abstract Objectives To estimate cost-effectiveness of 4 specialized nutritious foods (SNF) for Moderate Acute Malnutrition (MAM) treatment in children under five in Pujehun District, Sierra Leone Methods In a cluster randomized trial, a mobile supplementary feeding program was set up at 29 peripheral health units to treat children with MAM (mid-upper arm circumference (MUAC) ≥11.5 cm and <12.5 cm without bipedal edema) with 1 of 4 iso-caloric rations: Corn Soy Blend Plus w/oil (CSB + w/oil, reference), Corn Soy Whey Blend w/oil (CSWB w/oil), Super Cereal Plus w/amylase (SC + A), or Ready to Use Supplementary Food (RUSF). All foods were procured from U.S. except locally produced RUSF. Unlike RUSF and oil provided in commonly programmed specifications, CSB + , CSWB, and SC + A were produced in experimental package size or formulation at small scale. Caregivers picked up rations bi-weekly until children reached an outcome or up to 12 weeks. Collected from accounting records and study instruments using activity-based costing with ingredients, data on 10 components from implementer perspective (start-up, supply chain, and programming) were summarized into cost per enrolled child in 2018 USD for each arm. Other stakeholders’ costing perspectives will also be analyzed. To assess cost-effectiveness by arm, cost per recovered child = cost per enrolled child/graduation rate. Predicted means of crude graduation rate (% of children reaching MUAC ≥12.5 cm in 12 weeks) with 95% confidence intervals were estimated from unadjusted mixed-effect model to construct crude cost-effectiveness ranges. Future analyses will be based on adjusted modeling and realistically estimated product costs at scaled production. Results Children (N = 2681) received similar number of bi-weekly rations by arm. Product and international freight were top drivers of cost differences across arms. Crude graduation rate was not statistically different by arm. Cost per enrolled child ranged from $86 in RUSF to $94 in SC + A. Cost per recovered child was $137 ($130 - 145) in RUSF, $142 ($134 - 151) in CSB + w/oil, $146 ($138 - 155) in SC + A, and $149 ($140 - 160) in CSWB w/oil. Conclusions Crude cost-effectiveness to treat MAM considering only implementer cost was similar across 4 SNFs. Funding Sources Office of Food for Peace, Bureau for Democracy, Conflict, and Humanitarian Assistance, U.S. Agency for International Development.

scholarly journals Association of Body Composition and Sarcopenia with NASH in Obese Patients

2021 ◽  
Vol 10 (15) ◽  
pp. 3445
Author(s):  
Sophia Marie-Therese Schmitz ◽  
Lena Schooren ◽  
Andreas Kroh ◽  
Alexander Koch ◽  
Christine Stier ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Body Composition ◽  
Fat Mass ◽  
Inflammatory Diseases ◽  
Statistical Significance ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Obese Patients ◽  
Skeletal Muscle Index ◽  
P Values

Obese patients often suffer from sarcopenia or sarcopenic obesity (SO) that can trigger inflammatory diseases including non-alcoholic steatohepatitis (NASH). Sarcopenia and SO can be diagnosed through measuring parameters of body composition such as skeletal muscle mass (SMM), skeletal muscle index (SMI) and fat mass (FM) obtained by bioelectrical impedance analysis (BIA). The aim of this study was to assess the relationship of body composition and NASH in patients with obesity. A total of 138 patients with obesity that underwent bariatric surgery were included in this study. BIA was used to estimate body composition. A liver biopsy was taken intraoperatively and histological assessment of NASH was performed. A total of 23 patients (17%) were classified as NASH and 65 patients (47%) met the criteria for borderline NASH. Body mass index (BMI) was significantly higher in patients with NASH compared to borderline NASH and no NASH (56.3 kg/m2 vs. 51.6 kg/m2 vs. 48.6 kg/m2, p = 0.004). Concerning body composition, FM, but also SMM and SMI were significantly higher in patients with NASH (p-values 0.011, 0.005 and 0.006, resp.). Fat mass index (FMI) and weight-adjusted skeletal muscle index (SMI_weight) failed to reach statistical significance (p-values 0.067 and 0.661). In patients with obesity, higher FM were associated with NASH. Contrary to expectations, SMM and SMI were also higher in patients with NASH. Therefore, higher body fat, rather than sarcopenia and SO, might be decisive for development of NASH in patients with obesity.

scholarly journals Host Fecal mRNAs Predicted Environmental Enteric Dysfunction among Children with Moderate Acute Malnutrition in Sierra Leone

2021 ◽  
Author(s):  
Akriti Singh ◽  
Isabel Potani ◽  
Stacy P. Griswold ◽  
Devika Suri ◽  
Breanne Langlois ◽  
...  
Keyword(s):  
Sierra Leone ◽  
High Sensitivity ◽  
Cluster Randomized Trial ◽  
Child Growth ◽  
Acute Malnutrition ◽  
Random Forest Classification ◽  
Forest Classification ◽  
Environmental Enteric Dysfunction ◽  
Mrna Transcripts ◽  
Moderate Acute Malnutrition

Examining the role of environmental enteric dysfunction (EED) in child growth requires noninvasive, field-appropriate biomarkers. Alternatives to the traditionally used lactulose:mannitol (L:M) test have been explored, but few studies have compared the L:M test to host fecal mRNA transcripts. The objectives of this study were to examine whether 1) host fecal mRNA transcripts could predict presence and severity of EED, measured using the L:M test, and 2) EED modifies the effect of specialized nutritious foods (SNFs) on recovery from moderate acute malnutrition (MAM). This substudy was nested within a cluster randomized trial comparing four SNFs in the treatment of MAM among children 6 to 59 months in Sierra Leone. EED was assessed at enrollment using the L:M test and 15 host fecal mRNA transcripts on 522 children. Recovery from MAM was defined as achieving mid-upper arm circumference ≥ 12.5 cm within 12 weeks of supplementation. Random forest classification models were used to examine prediction of presence and severity of EED by host fecal mRNA transcripts. Logistic regression was used to test for effect modification by L:M test variables including % lactulose excreted (%L). Eight host fecal mRNA transcripts (AQP9, REG3A, IFI30, DECR1, BIRC3, SELL, PIK3AP1, DEFA6) identified EED (%L ≥ 0.2) and severe EED (%L ≥ 0.45) with high sensitivity and specificity. The L:M test variables did not modify the effect of SNFs on recovery from MAM. In this study, we found host fecal mRNA transcripts that could be biomarkers of EED but did not find EED to modify the effect of SNFs on MAM treatment.

Weight loss and exercise differentially affect insulin sensitivity, body composition, cardiorespiratory fitness and muscle strength in older adults with obesity; a randomized controlled trial

2021 ◽  
Author(s):  
Andrea M Brennan ◽  
Robert A Standley ◽  
Steven J Anthony ◽  
Kory E Grench ◽  
Nicole L Helbling ◽  
...  
Keyword(s):  
Older Adults ◽  
Weight Loss ◽  
Body Composition ◽  
Adipose Tissue ◽  
Insulin Sensitivity ◽  
Lean Mass ◽  
Disease Risk ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Intermuscular Adipose Tissue

Abstract Background Aging-related disease risk is exacerbated by obesity and physical inactivity. It is unclear how weight loss and increased activity improve risk in older adults. We aimed to determine the effects of diet-induced weight loss with and without exercise on insulin sensitivity, VO2peak, body composition, and physical function in older obese adults. Methods Physically inactive older (68.6 ± 4.5 years) obese (BMI 37.4 ± 4.9 kg/m 2) adults were randomized to: Health education control (HEC; n=25); Diet-induced weight loss (WL; n=31); or Weight loss and exercise (WLEX; n=28) for 6 months. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp, body composition by DXA and MRI, strength by isokinetic dynamometry, and VO2peak by graded exercise test. Results WLEX improved (p&lt;0.05) peripheral insulin sensitivity (+75 ± 103%) vs. HEC (+12 ± 67%); WL (+36 ± 47%) vs. HEC did not reach statistical significance. WLEX increased VO2peak (+7 ± 12%) vs. WL (-2 ± 24%), and prevented reductions in strength and lean mass induced by WL (p&lt;0.05). WLEX decreased abdominal adipose tissue (-16 ± 9%) vs. HEC (-3 ± 8%) and intermuscular adipose tissue (-15 ± 13 %) vs. both HEC (+9 ± 15%) and WL (+2 ± 11%) (p&lt;0.01). Conclusions Exercise with weight loss improved insulin sensitivity and VO2peak, decreased ectopic fat, and preserved lean mass and strength. Weight loss alone decreased lean mass and strength. Older adults intending to lose weight should perform regular exercise to promote cardiometabolic and functional benefits, which may not occur with calorie restriction-induced weight loss alone.

scholarly journals Severe and Moderate Acute Malnutrition Can Be Successfully Managed with an Integrated Protocol in Sierra Leone

2015 ◽  
Vol 145 (11) ◽  
pp. 2604-2609 ◽  
Author(s):  
Amanda Maust ◽  
Aminata S Koroma ◽  
Caroline Abla ◽  
Nneka Molokwu ◽  
Kelsey N Ryan ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Acute Malnutrition ◽  
Moderate Acute Malnutrition

scholarly journals Lactulose: Mannitol Test as an Indicator of a Potential Modifier of the Effect of Specialized Nutritious Foods in the Treatment of Moderate Acute Malnutrition in Sierra Leone (P10-122-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Akriti Singh ◽  
Isabel Potani ◽  
Stacy Griswold ◽  
Devika Suri ◽  
Breanne Langlois ◽  
...  
Keyword(s):  
International Development ◽  
Treatment Program ◽  
Severe Acute Malnutrition ◽  
Cluster Randomized Trial ◽  
Effect Modification ◽  
Humanitarian Assistance ◽  
Acute Malnutrition ◽  
Watery Stool ◽  
Clinical Complications ◽  
Moderate Acute Malnutrition

Abstract Objectives The objective of the study was to examine whether EED at enrollment modifies the effect of specialized nutritious foods (SNFs) on graduation from a moderate acute malnutrition (MAM) treatment program. Methods This sub-study was nested within a cluster randomized trial of MAM children 6–59 months of age supplemented with one of four SNFs: Super Cereal Plus w/amylase (SC + A), Corn Soy Blend Plus w/oil (CSB + w/oil - referent), Corn Soy Whey Blend w/oil (CSWB w/oil), and Ready to Use Supplementary Food (RUSF). Children with mid-upper arm circumference (MUAC) ≥11.5 cm and <12.5 cm with no clinical complications were enrolled. Children received the study food until they reached MUAC ≥12.5 cm or up to 12 weeks. EED was assessed at enrollment using the lactulose: mannitol (L: M) test. Samples from 387 participants were analyzed. Logistic regression was used to test for effect modification by L: M ratio (LM), L: M excretion ratio (LMER), and % lactulose excreted (%L). Results At enrollment, the mean ± SD age of sub-study participants was 14.5 ± 9.12 months, 57% were female, and 24% previously had severe acute malnutrition (SAM). The median LM was 0.49 (interquartile range, IQR = 0.42), LMER was 0.10 (IQR = 0.08), and %L was 0.34 (IQR = 0.42). The overall graduation rate was 66% (range: 60% to 74% by food). LMER, LM, and %L did not modify the effect of the study foods in unadjusted models (P = 0.116, P = 0.116, P = 0.176), and models adjusted for age, gender, and previous SAM (P = 0.057, P = 0.057, P = 0.337). Analysis excluding children with watery stool after L: M dosing (N = 16), but not before as reported by the caregiver, showed statistically significant effect modification by LMER (P = 0.03; SC + A vs. CSB + : β = 12.69, P = 0.013) and L: M ratio (P = 0.03, SC + A vs. CSB + : β = 2.55, P = 0.013). Conclusions In this study we did not find EED (L: M test) at enrollment to modify the effect of SNFs on likelihood of graduation from a MAM treatment program. This may be because EED did not affect graduation from the program, or because EED severity changes over the course of treatment. Watery stool post L: M dosing should be systematically recorded and its effect assessed in analysis. Funding Sources This work was supported by the Office of Food for Peace, Bureau for Democracy, Conflict, and Humanitarian Assistance, U.S. Agency for International Development.

Sign in / Sign up

Export Citation Format

Share Document