Community-based Clinical Trial With Microbiota-directed Complementary Foods (MDCFs) Made of Locally Available Food Ingredients for the Management of Children With Primary Moderate Acute Malnutrition

2019 ◽  
Author(s):  
Keyword(s):  
Clinical Trial ◽  
Acute Malnutrition ◽  
Complementary Foods ◽  
Community Based ◽  
Food Ingredients ◽  
Moderate Acute Malnutrition

scholarly journals A Local Ingredients-Based Supplement Is Not Inferior to Corn-soya Blends Plus for the Treatment of Moderate Acute Malnutrition Among Children Aged 6 to 59 Months in Wolaita

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 276-276
Author(s):  
Debritu Satato ◽  
Anne Hatløy ◽  
Bernt Lindtjørn ◽  
Elazar Balla
Keyword(s):  
Intervention Group ◽  
Development Program ◽  
Development Cooperation ◽  
Acute Malnutrition ◽  
Food Supplementation ◽  
Control Group ◽  
Management Approach ◽  
Recovery Rates ◽  
Food Ingredients ◽  
Moderate Acute Malnutrition

Abstract Objectives Moderate acute malnutrition (MAM) is widespread and a persistent public health problem in developing countries. Currently, the management approach of MAM is focused on food supplementation, but it is limited to chronically food-insecure areas. This study aims to develop local-ingredients based supplement (LIBS) and evaluate if it is comparable to the corn-soya blend plus (CSB+) in treating MAM among children aged 6 to 59 months in Wolaita, Ethiopia. Methods Collection of food ingredients that have the potential for making LIBS was done. Sorting, soaking, roasting, and milling of ingredients were done. The LIBS, with an improved amount of nutrients, was used to test the effectiveness in treating MAM. To evaluate the effectiveness of LIBS compared with CSB+ in treating MAM, we used a randomized controlled non-inferiority trial among 324 moderately wasted children aged 6 to 59 months in Wolaita, Ethiopia. The daily ration was: 100 gm of LIBS plus 25.2 gm of sugar with 8 ml oil in the intervention group and 150 gm of CSB+ with 16 ml of oil in the control group. A chi-square test was used for the comparison of recovery rates between two groups. Kaplan-Meier (log-rank) survival analysis was done to estimate the recovery time and survival curves. Results Four food samples of LIBS were made with different portions of ingredients. One of the LIBS with the highest portion of pumpkin seed and selected for testing had an improved amount of protein, fat, energy, iron, zinc and potassium contents. Its proximate composition indicated protein and fat contents of 22.6 g/100 g and 32.9 g/100 g respectively. The trial results showed that there is no difference in baseline characteristics between the two groups (p > 0.05). The recovery rate for LIBS (n = 105 of 162; 64.8%) was similar to that for CSB+ (n = 108 of 162; 66.7%) (P = 0.6). The duration of recovery was similar for the LIBS group, with a median of 56 days compared to 63 days for the CSB+ group (P = 0.92). Conclusions The LIBS has contained adequate amount of nutrients needed for the treatment of MAM. There was no difference in recovery rates as well as recovery times for those who received LIBS and those who received CSB+ . Thus, LIBS has the same potential to treat MAM as CSB+ . Funding Sources Norwegian Agency for Development Cooperation (NORAD); Norwegian Program for Capacity Development in Higher Education and Research for Development Program (NORHED).

scholarly journals Percent Fat Mass Increases with Recovery, But Does Not Vary According to Dietary Therapy in Young Malian Children Treated for Moderate Acute Malnutrition

2019 ◽  
Vol 149 (6) ◽  
pp. 1089-1096 ◽  
Author(s):  
Christine M McDonald ◽  
Robert S Ackatia-Armah ◽  
Seydou Doumbia ◽  
Roland Kupka ◽  
Christopher P Duggan ◽  
...  
Keyword(s):  
Dietary Supplements ◽  
Fat Mass ◽  
Treatment Effectiveness ◽  
Deuterium Oxide ◽  
Acute Malnutrition ◽  
Dietary Therapy ◽  
Dilution Method ◽  
Community Based ◽  
Recovery Status ◽  
Moderate Acute Malnutrition

ABSTRACT Background Moderate acute malnutrition (MAM) affects 34.1 million children globally. Treatment effectiveness is generally determined by the amount and rate of weight gain. Body composition (BC) assessment provides more detailed information on nutritional stores and the type of tissue accrual than traditional weight measurements alone. Objective The aim of this study was to compare the change in percentage fat mass (%FM) and other BC parameters among young Malian children with MAM according to receipt of 1 of 4 dietary supplements, and recovery status at the end of the 12-wk intervention period. Methods BC was assessed using the deuterium oxide dilution method in a subgroup of 286 children aged 6–35 mo who participated in a 12-wk community-based, cluster-randomized effectiveness trial of 4 dietary supplements for the treatment of MAM: 1) lipid-based, ready-to-use supplementary food (RUSF); 2) special corn–soy blend “plus plus” (CSB++); 3) locally processed, fortified flour (MI); or 4) locally milled flours plus oil, sugar, and micronutrient powder (LMF). Multivariate linear regression modeling was used to evaluate change in BC parameters by treatment group and recovery status. Results Mean ± SD %FM at baseline was 28.6% ± 5.32%. Change in %FM did not vary between groups. Children who received RUSF vs. MI gained more (mean; 95% CI) weight (1.43; 1.13, 1.74 kg compared with 0.84; 0.66, 1.03 kg; P = 0.02), FM (0.70; 0.45, 0.96 kg compared with 0.20; 0.05, 0.36 kg; P = 0.01), and weight-for-length z score (1.23; 0.79, 1.54 compared with 0.49; 0.34, 0.71; P = 0.03). Children who recovered from MAM exhibited greater increases in all BC parameters, including %FM, than children who did not recover. Conclusions In this study population, children had higher than expected %FM at baseline. There were no differences in %FM change between groups. International BC reference data are needed to assess the utility of BC assessment in community-based management of acute malnutrition programs. This trial was registered at clinicaltrials.gov as NCT01015950.

scholarly journals Ready-to-Use Therapeutic Food Made From Locally Available Food Ingredients Is Well Accepted by Children Having Severe Acute Malnutrition in Bangladesh

2017 ◽  
Vol 39 (1) ◽  
pp. 116-126 ◽  
Author(s):  
Nuzhat Choudhury ◽  
Tahmeed Ahmed ◽  
Md Iqbal Hossain ◽  
M. Munirul Islam ◽  
Shafiqul A. Sarker ◽  
...  
Keyword(s):  
Energy Content ◽  
Severe Acute Malnutrition ◽  
Diarrhoeal Disease ◽  
Acute Malnutrition ◽  
Community Based ◽  
Food Ingredients ◽  
Total Energy Content ◽  
Significant Difference ◽  
The Mean ◽  
Therapeutic Food

Background: With a prevalence of 3.1%, approximately, 450 000 children in Bangladesh are having severe acute malnutrition (SAM). There is currently no national community-based program run by government to take care of these children, one of the reasons being lack of access to ready-to-use therapeutic food (RUTF). Objective: To develop RUTF using locally available food ingredients and test its acceptability. Methods: A checklist was prepared for all food ingredients available and commonly consumed in Bangladesh that have the potential of being used for developing a RUTF. Linear programming was used to identify the combinations of nutrients that would result in an ideal RUTF. To test the acceptability of 2 local RUTFs compared to the prototype RUTF, Plumpy’Nut, a clinical trial with a crossover design was conducted among 30 children in the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh. The acceptability was determined by using the mean proportion of offered food consumed by the children themselves. Results: Two RUTFs were developed, one based on chickpea and the other on rice–lentils. The total energy content of 100 g of chickpea and rice–lentil-based RUTF were 537.4 and 534.5 kcal, protein 12.9 and 13.5 g, and fat 31.8 and 31.1 g, respectively, without any significant difference among the group. On an average, 85.7% of the offered RUTF amount was consumed by the children in 3 different RUTF groups which implies that all types of RUTF were well accepted by the children. Conclusion: Ready-to-use therapeutic foods were developed using locally available food ingredients—rice, lentil, and chickpeas. Chickpea-based and rice–lentil-based RUTF were well accepted by children with SAM.

Community-Based Management of Acute Malnutrition for Infants Under 6 Months of Age Is Safe and Effective: Analysis of Operational Data

2021 ◽  
pp. 1-27
Author(s):  
Maeve M. Woeltje ◽  
Anastasia B. Evanoff ◽  
Beth A. Helmink ◽  
Diana L. Culbertson ◽  
Kenneth M. Maleta ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Community Based ◽  
Malnourished Children ◽  
Nutritional Recovery ◽  
Economic Barriers ◽  
Moderate Acute Malnutrition ◽  
Supplementary Foods ◽  
Operational Data

Abstract Objective: To assess the effectiveness of outpatient management with ready-to-use and supplementary foods for infants under 6 months (u6m) of age who were unable to be treated as inpatients due to social and economic barriers. Design: Review of operational acute malnutrition treatment records. Setting: 21 outpatient therapeutic feeding clinics in rural Malawi. Participants: Infants u6m with acute malnutrition treated as outpatients because of barriers to inpatient treatment. The comparison group consisted of acutely malnourished children 6-9 months of age who were being treated at the same time in the same location in the context of two different randomized clinical trials. Results: A total of 323 infants u6m were treated for acute malnutrition (130 severe and 193 moderate). A total of 357 infants 6-9 months old with acute malnutrition (74 severe and 283 moderate) were included as contemporaneous controls. Among infants u6m with severe acute malnutrition, 98 (75.4%) achieved nutritional recovery; in comparison, 56 (75.7%) of those with SAM 6-9 months old recovered. Among infants u6m with moderate acute malnutrition, 157 (81.3%) recovered; in comparison 241 (85.2%) of those aged 6-9 months recovered. Conclusions: In a rural Malawian population of infants u6m who had generally already stopped exclusive breastfeeding and were now acutely malnourished, treatment with therapeutic or supplementary foods under the community management of acute malnutrition model was safe and effective. In settings where social and financial factors make hospital admission challenging, consideration should be given to lowering the recommended age of ready-to-use therapeutic and supplementary foods to infants u6m.

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