Malian children with moderate acute malnutrition who are treated with lipid-based dietary supplements have greater weight gains and recovery rates than those treated with locally produced cereal-legume products: a community-based, cluster-randomized trial. Effect of Mass Supplementation with Ready-to-Use Supplementary Food during an Anticipated Nutritional Emergency Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial. An energy-dense complementary food is associated with a modest increase in weight gain when compared with a fortified porridge in Malawian children aged 6-18 months. Comparison of the efficacy of a solid ready-to-use food and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trial. An effectiveness trial showed lipid-based nutrient supplementation but not corn-soya blend offered a modest benefit in weight gain among 6- to 18-month-old underweight children in rural Malawi. Evaluation of the acceptability of improved supplementary foods for the treatment of moderate acute malnutrition in Burkina Faso using a mixed method approach Effectiveness of ready-to-use therapeutic food compared to a corn/soy-blend-based pre-mix for the treatment of childhood moderate acute malnutrition in Niger. Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. Locally made ready-to-use therapeutic food for treatment of malnutrition: A randomized controlled trial A lipid-based nutrient supplement but not corn-soy blend modestly increases weight gain among 6- to 18-month-old moderately underweight children in rural Malawi. Supplementary feeding with fortified spreads results in higher recovery rates than with a corn/soy blend in moderately wasted children. Treating moderate acute malnutrition in first-line health services: an effectiveness cluster-randomized trial in Burkina Faso. Short children with a low midupper arm circumference respond to food supplementation: an observational study from Burkina Faso. Supplemental feeding with ready-to-use therapeutic food in Malawian children at risk of malnutrition. Treatment of moderate acute malnutrition with ready-to-use supplementary food results in higher overall recovery rates compared with a corn-soya blend in children in southern Ethiopia: an operations research trial. Supplementary feeding with fortified spread among moderately underweight 6-18-month-old rural Malawian children. Supplementary Feeding of Underweight, Stunted Malawian Children With a Ready-To-Use Food Locally produced ready-to-use supplementary food is an effective treatment of moderate acute malnutrition in an operational setting Recovery rate of children with moderate acute malnutrition treated with ready-to-use supplementary food (RUSF) or improved corn-soya blend (CSB+): a randomized controlled trial. Effect of Short-Term Supplementation with Ready-to-Use Therapeutic Food or Micronutrients for Children after Illness for Prevention of Malnutrition: A Randomised Controlled Trial in Nigeria A hand-made supplementary food for malnourished children. A novel fortified blended flour, corn-soy blend "plus-plus," is not inferior to lipid-based ready-to-use supplementary foods for the treatment of moderate acute malnutrition in Malawian children. Intensive nutrition education with or without supplementary feeding improves the nutritional status of moderately-malnourished children in Bangladesh. Growth and Change in Blood Haemoglobin Concentration Among Underweight Malawian Infants Receiving Fortified Spreads for 12 Weeks: A Preliminary Trial Children successfully treated for moderate acute malnutrition remain at risk for malnutrition and death in the subsequent year after recovery.
BACKGROUND Moderate acute malnutrition ( MAM ) , defined as weight-for-length z score between -3 and -2 or midupper arm circumference between 11.5 and 12.5 cm , affects ∼33 million children aged < 5 y worldwide . OBJECTIVE The objective was to compare the effects of 4 dietary supplements for the treatment of MAM . DESIGN Twelve community health centers in rural Mali were r and omly assigned to provide to 1264 MAM children aged 6 - 35 mo one of 4 dietary supplements containing ∼500 kcal/d for 12 wk : 1 ) ready-to-use , lipid-based supplementary food ( RUSF ) ; 2 ) special corn-soy blend ( CSB++ ) ; 3 ) locally processed , fortified flour ( Misola ) ; or 4 ) locally milled flours plus oil , sugar , and micronutrient powder ( LMF ) . RESULTS In total , 1178 children ( 93.2 % ) completed the study . The adjusted mean ( 95 % CI ) change in weight ( kg ) from baseline was greater with RUSF than with the locally processed blends and was intermediate with CSB++ [ 1.16 ( 1.08 , 1.24 ) for RUSF , 1.04 ( 0.96 , 1.13 ) for CSB++ , 0.91 ( 0.82 , 0.99 ) for Misola , and 0.83 ( 0.74 , 0.92 ) for LMF ; P < 0.001 ] . For length change , RUSF and CSB++ differed significantly from LMF . Sustained recovery rates were higher with RUSF ( 73 % ) than with Misola ( 61 % ) and LMF ( 58 % ) , P < 0.0001 ; CSB++ recovery rates ( 68 % ) did not differ from any of the other groups . CONCLUSIONS RUSF was more effective , but more costly , than other dietary supplements for the treatment of MAM ; CSB++ yielded intermediate results . The benefits of treatment should be considered in relation to product costs and availability Background Previous studies have shown the benefits of ready-to-use supplementary food ( RUSF ) distribution in reducing the incidence and prevalence of severe acute malnutrition . Methods and Findings To compare the incidence of wasting , stunting and mortality between children aged 6 to 23 mo participating and not participating in distributions of RUSF  , we implemented two exhaustive prospect i ve cohorts including all children 60 cm to 80 cm , resident in villages of two districts of Maradi region in Niger ( n = 2238 ) . Villages ( 20 ) were selected to be representative of the population . All registered children were eligible for the monthly distributions between July and October 2010 . Age , sex , height , weight , and Mid-Upper Arm Circumference ( MUAC ) were measured at baseline and two weeks after each distribution ; the amount and type of distribution and the amount shared and remaining were also assessed . We compared the incidence of wasting , stunting , and mortality among children participating in the distribution ( intervention ) of RUSF  versus children not participating in the distribution ( comparison ) . The absolute rate of wasting was 4.71 events per child-year ( 503 events/106.59 child-year ) in the intervention group and 4.98 events per child-year ( 322 events/64.54 child-year ) in the comparison group . The intervention group had a small but higher weight-for-length Z-score gain ( −0.2z vs. −0.3z ) and less loss of MUAC than the comparison group ( −2.8 vs. −4.0 mm ) . There was no difference in length gain ( 2.7 vs. 2.8 cm ) . Mortality was lower for children whose households received the intervention than those who did not ( adjusted HR 0.55 , 95 % CI : 0.32–0.98 ) . Conclusions Short-term distribution with RUSF for children 6 to 23 months improve the nutritional status of children at risk for malnutrition . Fewer children who participated in the RUSF distribution died than those who did not BACKGROUND Childhood malnutrition is common in Malawi , and the st and ard treatment , which follows international guidelines , results in poor recovery rates . Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food ( RUTF ) . OBJECTIVE The objective was to compare the recovery rates among children with moderate and severe wasting , kwashiorkor , or both receiving either home-based therapy with RUTF or st and ard inpatient therapy .  DESIGN A controlled , comparative , clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children . Children were systematic ally allocated to either st and ard therapy ( 186 children ) or home-based therapy with RUTF ( 992 children ) according to a stepped wedge design to control for bias introduced by the season of the year . Recovery , defined as reaching a weight-for-height z score > -2 , and relapse or death were the primary outcomes . The rate of weight gain and the prevalence of fever , cough , and diarrhea were the secondary outcomes . RESULTS Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received st and ard therapy ( 79 % compared with 46 % ; P < 0.001 ) and were less likely to relapse or die ( 8.7 % compared with 16.7 % ; P < 0.001 ) . Children who received home-based therapy with RUTF had greater rates of weight gain ( 3.5 compared with 2.0 g . kg(-1 ) . d(-1 ) ; difference : 1.5 ; 95 % CI : 1.0 , 2.0 g . kg(-1 ) . d(-1 ) ) and a lower prevalence of fever , cough , and diarrhea than did children who received st and ard therapy . CONCLUSION Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is st and ard therapy Poor complementary feeding practice s are associated with stunting and growth faltering throughout the developing world . The objective was to compare the effect of using peanut-/soy-based fortified spread ( FS ) and corn porridge fortified with fish powder ( FP ) as complementary foods on growth in rural Malawian children . A total of 240 children were enrolled at the age of 6 mo and r and omized to receive FS or FP .  Both complementary foods provided 836 kJ/d from 6 to 9 mo of age and 1254 kJ/d from 9 to 18 mo of age . Children were followed monthly for anthropometry and fortnightly for the symptoms of fever , cough , or diarrhea until they were 18 mo old . Zn and Se status were assessed at 6 and 12 mo . The primary outcomes were the rates of weight and length gain from 6 - 12 mo and from 12 - 18 mo . Children who received FS gained 110 g more ( 95 % CI 220 to 10 ) from 6 - 12 mo of age than children receiving FP .  Weight gain did not differ between children receiving FS and FP between 12 and 18 mo of age , nor did statural growth from 6 to 12 mo or 12 to 18 mo . A total of 23 % of all children were Zn deficient at 6 mo of age and this increased to 37 % at 12 mo of age . Neither FS nor FP was associated with significantly improved Zn status .  FS was associated with better weight gain from 6 - 12 mo of age and may be useful in conjunction with additional interventions to improve infant growth in the developing world BACKGROUND The World Health Organization recommends a liquid , milk-based diet ( F100 ) during the rehabilitation phase of the treatment of severe malnutrition . A dry , solid , ready-to-use food ( RTUF ) that can be eaten without adding water has been proposed to eliminate the risk of bacterial contamination from added water . The efficacies of RTUF and F100 have not been compared . OBJECTIVE The objective was to compare the efficacy of RTUF and F100 in promoting weight gain in malnourished children . DESIGN In an open-labeled , r and omized trial , 70 severely malnourished Senegalese children aged 6 - 36 mo were r and omly allocated to receive 3 meals containing either F100 ( n = 35 ) or RTUF ( n = 35 ) in addition to the local diet . The data from 30 children in each group were analyzed . RESULTS The mean ( + /- SD ) daily energy intake in the RTUF group was 808 + /- 280 ( 95 % CI : 703.8 , 912.9 ) kJ x kg body wt(-1 ) x d(-1 ) , and that in the F100 group was 573 + /- 201 ( 95 % CI : 497.9 , 648.7 ) kJ. kg body wt(-1 ) x d(-1 ) ( P < 0.001 ) . The average weight gains in the RTUF and F100 groups were 15.6 ( 95 % CI : 13.4 , 17.8 ) and 10.1 ( 95 % CI : 8.7 , 11.4 ) g x kg body wt(-1 ) x d(-1 ) , respectively ( P < 0.001 ) . The difference in weight gain was greater in the most wasted children ( P < 0.05 ) . The average duration of rehabilitation was 17.3 ( 95 % CI : 15.6 , 19.0 ) d in the F100 group and was 13.4 ( 95 % CI : 12.1 , 14.7 ) d in the RTUF group ( P < 0.001 ) . CONCLUSIONS This study indicated that RTUF can be used efficiently for the rehabilitation of severely malnourished children OBJECTIVE To determine if supplementation with corn-soya blend ( CSB ) or lipid-based nutrient supplement ( LNS ) improved the weight gain of moderately underweight infants and children when provided through the national health service . DESIGN A r and omised , controlled , assessor-blinded clinical trial . Infants and children were r and omised to receive for 12 weeks an average daily ration of 71 g CSB or 43 g LNS , providing 1188 kJ and 920 kJ , respectively , or no supplement ( control ) . Main outcome was weight gain . Secondary outcomes included changes in anthropometric indices and incidence of serious adverse events . Intention-to-treat analyses were used . SETTING Kukalanga , Koche , Katema and Jalasi health centres in Mangochi District , rural Malawi . SUBJECTS Underweight ( weight-for-age Z-score < -2 ) infants and children aged 6 - 15 months ( n 299 ) .  RESULTS Mean weight gain was 630 g , 680 g and 750 g in control , CSB and LNS groups , respectively ( P = 0·21 ) . When adjusted for baseline age , children receiving LNS gained on average 90 g more weight ( P = 0·185 ) and their weight-for-length Z-score increased 0·22 more ( P = 0·049 ) compared with those receiving no supplementation . No statistically significant differences were observed between the CSB and control groups in mean weight and length gain . CONCLUSIONS LNS supplementation provided during the lean season via through the national health service was associated with a modest increase in weight . However , the effect size was lower than that previously reported under more controlled research setting The objective of this study was to evaluate , within the context of a r and omized controlled trial of product effectiveness , the acceptability of new formulations of six corn-soy blended flours ( CSB ) and six lipid-based nutrient supplements ( LNS ) with different quantities of milk and qualities of soy for the treatment of children with moderate acute malnutrition ( MAM ) . Our study included 1546 children aged 6 - 23 months and involved question naires after one month of supplementation home visits and interviews with a sub- sample of 20 trial participants and their caretakers , and nine focus group discussion . All 12 products were well accepted in terms of organoleptic qualities and received good ratings . However , LNS were more appreciated by caretakers and children . Additionally , an effect of soy isolate was detected on child appreciation where products with high milk content also received better ratings .  CSB  were not consumed as readily ; 33.9 % ( n = 257 ) of children receiving CSB were reported to have leftovers compared to 17.3 % ( n = 134 ) of children receiving LNS ( p=<0.001 ) . Both CSB and LNS were referred to as foods with medicinal properties and perceived as beneficial to child health . They were both reported to have high priority in the daily feeding of the child . In conclusion , there were minimal differences in acceptability of the various CSB and LNS formulations , although CSB were less readily consumed and required smaller meal volumes . Since all products were well-accepted , decisions regarding whether the more expensive products should be used for the treatment of MAM will need to be based on their effect on child nutrition , growth and health . Future supplementary feeding programs in similar context s could furthermore consider introducing supplementary foods as a medical treatment , as this may increase adherence and decrease sharing St and ard nutritional treatment of moderate acute malnutrition ( MAM ) relies on fortified blended flours though their importance to treat this condition is a matter of discussion . With the newly introduced World Health Organization growth st and ards , more children at an early stage of malnutrition will be treated following the dietary protocol s as for severe acute malnutrition , including ready-to-use therapeutic food ( RUTF ) . We compared the effectiveness of RUTF and a corn/soy-blend (CSB)-based pre-mix for the treatment of MAM in the supplementary feeding programmes ( SFPs ) supported by Médecins Sans Frontières , located in the Zinder region ( south of Niger ) . Children measuring 65 to < 110 cm , newly admitted with MAM [ weight-for-height ( WHM% ) between 70 % and < 80 % of the NCHS median ] were r and omly allocated to receive either RUTF ( Plumpy'Nut ® , 1000 kcal day(-1 ) ) or a CSB pre-mix ( 1231 kcal day(-1 ) ) . Other interventions were similar in both groups ( e.g. weekly family ration and ration at discharge ) . Children were followed weekly up to recovery ( WHM% ≥ 85 % for 2 consecutive weeks ) . In total , 215 children were recruited in the RUTF group and 236 children in the CSB pre-mix group with an overall recovery rate of 79.1 and 64.4 % , respectively ( p < 0.001 ) . There was no evidence for a difference between death , defaulter and non-responder rates . More transfers to the inpatient Therapeutic Feeding Centre ( I-TFC ) were observed in the CSB pre-mix group ( 19.1 % ) compared to the RUTF group ( 9.3 % ) ( p = 0.003 ) . The average weight gain up to discharge was 1.08 g kg(-1 ) day(-1 ) higher in the RUTF group [ 95 % confidence interval : 0.46 - 1.70 ] and the length of stay was 2 weeks shorter in the RUTF group ( p < 0.001 ) . For the treatment of childhood MAM in Niger  , RUTF result ed in a higher weight gain , a higher recovery rate , a shorter length of stay and a lower transfer rate to the I-TFC compared to a CSB pre-mix . This might have important implication s on the efficacy and the quality of SFPs OBJECTIVE To compare growth and incidence of malnutrition in infants receiving long-term dietary supplementation with ready-to-use fortified spread ( FS ) or micronutrient-fortified maize-soy flour ( likuni phala [ LP ] ) . DESIGN R and omized , controlled , single-blind trial . SETTING Rural Malawi . PARTICIPANTS A total of 182 six-month-old infants . INTERVENTION Participants were r and omized to receive 1 year of daily supplementation with 71 g of LP ( 282 kcal ) , 50 g of FS ( FS50 ) ( 256 kcal ) , or 25 g of FS ( FS25 ) ( 130 [ corrected ] kcal ) . OUTCOME MEASURES Weight and length gains and the incidences of severe stunting , underweight , and wasting . RESULTS Mean weight and length gains in the LP , FS50 , and FS25 groups were 2.37 , 2.47 , and 2.37 kg ( P = .66 ) and 12.7 , 13.5 , and 13.2 cm ( P = .23 ) , respectively . In the same groups , the cumulative 12-month incidence of severe stunting was 13.3 % , 0.0 % , and 3.5 % ( P = .01 ) , of severe underweight was 15.0 % , 22.5 % , and 16.9 % ( P = .71 ) , and of severe wasting was 1.8 % , 1.9 % , and 1.8 % ( P > .99 ) . Compared with LP-supplemented infants , those given FS50 gained a mean of 100 g more weight and 0.8 cm more length . There was a significant interaction between baseline length and intervention ( P = .04 ) ; in children with below-median length at enrollment , those given FS50 gained a mean of 1.9 cm more than individuals receiving LP . CONCLUSION One-year-long complementary feeding with FS does not have a significantly larger effect than LP on mean weight gain in all infants , but it is likely to boost linear growth in the most disadvantaged individuals and , hence , decrease the incidence of severe stunting Objective To evaluate the effectiveness of a locally made ready-to-use therapeutic food ( RUTF ) in decreasing mild to moderate malnutrition . Design A r and omized open label , controlled trial . Setting Pre-schools run by the Department of Community Health in Kaniyambadi administrative block , Vellore , India ; duration of follow-up - 3 months from the date of recruitment . Participants Pupils aged 18–60 months with Weight-for-Age ≤2 SD . Interventions A locally produced energy-dense supplement ( RUTF ) , and the current st and ard of care [ teaching caregivers how to make a fortified cereal-milk supplement called High Calorie Cereal Milk (HCCM)].Main outcome measures Increase in weight-for-age status ; increase in levels of plasma zinc , vitamin B12 , serum albumin and haemoglobin . Results The Mean ( SD ) weight gain at 3 months was higher in the RUTF group : RUTF ( n=51 ) : 0.54 kg ; ( SE = 0.05 ; 95 % CI = 0.44–0.65 ) vs HCCM ( n=45 ) : 0.38 kg ; ( SE = 0.06 ; 95 % CI = 0.25–0.51 ) , P = 0.047 . The weight gain per kilogram of body weight was directly proportional to the severity of malnutrition . Conclusions Community-based treatment showed weight gain in both groups , the gain being higher with RUTF Although widely used , there is little information concerning the efficacy of corn-soy blend ( CSB ) supplementation in the treatment of moderate underweight in African children .  Lipid-based nutrient supplements ( LNS ) , which have proven to be beneficial treatment for severely wasted children , could offer benefits to less severely affected individuals . We conducted a clinical r and omized trial to determine whether LNS or CSB supplementation improves weight gain of moderately underweight children . A total of 182 underweight [ weight-for-age Z-score ( WAZ ) < -2 ] 6- to 15-mo-old children were r and omized to receive for 12 wk a ration of 43 g/d LNS or 71 g/d CSB , providing 1189 and 921 kJ , respectively , or no supplementation ( control ) . The primary outcome was weight change ; secondary outcomes included changes in anthropometric indices , hemoglobin levels , and morbidity . The body weight increases ( mean ± SD ) did not differ and were 620 ± 470 , 510 ± 350 , and 470 ± 350 g in the LNS , CSB , and control groups , respectively ( P = 0.11 ) . Compared with controls , infants and children in the LNS group gained more weight [ mean ( 95 % CI ) = 150 g ( 0 - 300 g ) ; P = 0.05 ] and had a greater increase in WAZ [ 0.33 ( -0.02 - 0.65 ) ; P = 0.04 ] . Weight and WAZ changes did not differ between the control and CSB groups . In exploratory stratified analysis , the weight increase was higher in the LNS group compared with the control group among those with lower initial WAZ [ 250 g ( 60 - 430 g ; P = 0.01 ] . Supplementation with LNS but not CSB modestly increases weight gain among moderately underweight children and the effect appears most pronounced among those with a lower initial WAZ Moderate childhood wasting is defined as having a weight-for-height Z-score ( WHZ ) < -2 , but > or = -3 . These children are typically given fortified corn/soy blended flour ( CSB ) , but this intervention has shown limited effectiveness . Fortified spreads ( FS ) can be used as supplementary foods instead ; they are energy-dense , lipid-based pastes with added powdered micronutrients . In this r and omized clinical effectiveness trial , the recovery rates were compared among children with moderate wasting who received either milk/peanut FS , soy/peanut FS , or CSB .  Children received isoenergetic quantities of food , 314 kJ x kg(-1 ) x d(-1 ) , for up to 8 wk with biweekly follow-up . The primary outcome was recovery , defined as having a WHZ > -2 . Time-event analysis was used to compare the recovery rate . A total of 1362 children were enrolled in the study . Children receiving soy/peanut FS had a similar recovery rate to those receiving milk/peanut FS and children in either FS group were more likely to recover than those receiving CSB ( 80 % in both FS groups vs. 72 % in the CSB group ; P < 0.01 ) . The rate of weight gain in the first 2 wk was greater among children receiving milk/peanut FS ( 2.6 g x kg(-1 ) x d(-1 ) , n = 465 ) or children receiving soy/peanut FS ( 2.4 g x kg(-1 ) x d(-1 ) , n = 450 ) than among children receiving CSB ( 2.0 g x kg(-1 ) x d(-1 ) , n = 447 ; P < 0.05 ) . Rates of length gain did not differ among the 3 groups . A total of 8 % of children in each feeding group developed edema , indicative of severe malnutrition , while receiving supplemental feeding . We conclude that FS are superior supplementary foods to CSB for moderately wasted Malawian children BACKGROUND Management of moderate acute malnutrition ( MAM ) is , currently , focused on food supplementation approaches . However , the sustainability of these strategies remains weak in low- and middle-income countries . In food-secure setting s , an educational/behavioral intervention could be an alternative for improving MAM management . OBJECTIVE This study compared the effectiveness of weekly context -appropriate child-centered counseling ( CCC ) , with an improved corn-soy blend [ corn-soy blend with added micronutrients ( CSB++ ) ] or a locally produced ready-to-use supplementary food ( RUSF ) , in treating MAM through first-line rural health services . DESIGN We used a cluster r and omized controlled trial design with 3 arms , involving 18 rural health centers ( 6 by arm ) and children aged 6 - 24 mo with uncomplicated MAM . In the first arm ( CCC ) , trained health workers provided weekly personalized counseling to caretakers . In the 2 other arms , children received weekly either 455 g CSB++ or 350 g locally produced soy-based RUSF . Both food supplements provided ∼250 kcal/d . RESULTS The recovery rate after 3 mo of treatment was significantly lower with CCC ( 57.8 % ) than with CSB++ ( 74.5 % ) and RUSF ( 74.2 % ) ( P < 0001 ) . Mothers ' attendance at health facilities was also substantially lower in the CCC arm ( P < 0001 ) ; this arm had a high defaulter rate ( P < 0.003 ) . When the analysis was adjusted for attendance , we did not find a significant difference between the 3 arms , with incidence rate ratios of 1.14 ( 95 % CI : 0.99 , 1.31 ) and 1.13 ( 95 % CI : 0.98 , 1.30 ) for the CSB++ and RUSF arms , respectively , compared with the CCC arm . CONCLUSION Whereas supplement-based treatment of MAM was found to be more effective than the provision of CCC , we hypothesize that appropriate and specific nutrition counseling centered on children 's needs , through primary health facilities , might be an alternative strategy for MAM treatment in rural food-secure areas , provided that attendance at counseling sessions by the caregiver is ensured . This trial was registered at clinical trials.gov as NCT01115647 BACKGROUND The management of children with moderate acute malnutrition ( MAM ) is based on food supplementation in outpatient programs . When midupper arm circumference ( MUAC ) is used as the sole admission criterion , it is common practice to exclude children with lengths < 67 cm from treatment . The WHO calls for research to determine the treatment effect among children with MAM included by MUAC and aged ≥6 mo with lengths < 67 cm . OBJECTIVE We hypothesized that among children given supplementary feeding based on an MUAC of 115 - 124 mm as the sole criterion , there would be no difference in growth rate between children < 67 cm and those ≥67 cm in length at program admission . DESIGN This was an observational study nested in a r and omized trial that investigated the effectiveness of new formulations of corn-soy blend and lipid-based nutrient supplements .  Children aged 6 - 23 mo were included if their MUAC was between 115 and 124 mm but with a weight-for-height z score ( WHZ ) ≥-2 . This cohort was divided into 2 groups by length at admission : < 67 cm ( " short " ) and ≥67 cm ( " long " ) . Linear mixed-effects models and regression models were used to compare gains in weight and MUAC while adjusting for intervention , season , sex , age , and site . RESULTS Weight-gain velocity ( expressed as g · kg(-1 ) · d(-1 ) ) and MUAC-gain velocity ( expressed as 0.01 mm · cm(-1 ) · d(-1 ) ) were not different between short and long children . Weight-gain velocity was slightly higher in the shortest quartile of length ( P = 0.03 ) , whereas there was no effect modification by stunting across length quartiles ( P = 0.32 ) . CONCLUSIONS We found no evidence of a difference in percentage of weight gain or weight-gain velocity  during supplementary feeding in short or long children aged 6 - 23 mo . We recommend a policy change to include children < 67 cm in supplementary feeding programs if their MUAC is between 115 and 124 mm and their WHZ is ≥-2 . This could benefit millions of children currently excluded from supplementary feeding . This trial was registered at www.controlled-trials.com as IS RCT N42569496 The study was a controlled , comparative clinical effectiveness trial of two supplementary feeding regimens in children at risk of malnutrition from seven centres in rural Malawi . Being at risk of malnutrition was defined as weight-for-height < 85 % , but > 80 % of the international st and ard . A stepped-wedge design with systematic allocation was used for assigning children to receive either ready-to-use therapeutic food ( RUTF ) ( n=331 ) or micronutrient-fortified corn/soy-blend ( n=41 ) for up to eight weeks . The primary outcomes were recovery , defined as weight-for-height > 90 % , and the rate of weight gain . Children receiving RUTF were more likely to recover ( 58 % vs 22 % ; difference 36 % ; 95 % confidence interval [ CI ] 20 - 52 ) and had greater rates of weight gain ( 3.1 g/kg.d vs 1.4 g/kg x d ; difference 1.7 ; 95 % CI 0.8 - 2.6 ) than children receiving corn/soy-blend . The results of this preliminary work suggest that supplementary feeding with RUTF promotes better growth in children at risk of malnutrition than the st and ard fortified cereal/legume-blended food BACKGROUND Moderate and severe acute malnutrition affects 13 % of children < 5 y of age worldwide . Severe acute malnutrition affects fewer children but is associated with higher rates of mortality and morbidity . Supplementary feeding programs aim to treat moderate acute malnutrition and prevent the deterioration to severe acute malnutrition . OBJECTIVE The aim was to compare recovery rates of children with moderate acute malnutrition in supplementary feeding programs by using the newly recommended ration of ready-to-use supplementary food ( RUSF ) and the more conventional ration of corn-soya blend ( CSB ) in Ethiopia . DESIGN A total of 1125 children aged 6 - 60 mo with moderate acute malnutrition received 16 wk of CSB or RUSF . Children were r and omly assigned to receive one or the other food . The daily rations were purpose ly based on the conventional treatment rations distributed at the time of the study in Ethiopia : 300 g CSB and 32 g vegetable oil in the control group ( 1413 kcal ) and 92 g RUSF in the intervention group ( 500 kcal ) . The higher ration size of CSB was provided because of expected food sharing . RESULTS The HR for children in the CSB group was 0.85 ( 95 % CI : 0.73 , 0.99 ) , which indicated that they had 15 % lower recovery ( P = 0.039 ) . Recovery rates of children at the end of the 16-wk treatment period trended higher in the RUSF group ( 73 % ) than in the CSB group ( 67 % ) ( P = 0.056 ) . CONCLUSION In comparison with CSB , the treatment of moderate acute malnutrition with RUSF result ed in higher recovery rates in children , despite the large ration size and higher energy content of the conventional CSB ration We aim ed to analyse growth and recovery from undernutrition among moderately underweight ambulatory children receiving micronutrient-fortified maize-soy flour ( Likuni Phala , LP ) or ready-to-use fortified spread ( FS ) supplementary diet . One hundred and seventy-six 6 - 18-month-old individuals were r and omized to receive 500 g LP or 350 g FS weekly for 12 weeks . Baseline and end of intervention measurements were used to calculate anthropometric gains and recovery from underweight , wasting and stunting . Mean weight-for-age increased by 0.22 ( 95 % CI 0.07 - 0.37 ) and 0.28 ( 0.18 - 0.40 ) Z-score units in the LP and FS groups respectively . Comparable increase for mean weight-for-length was 0.39 ( 0.20 - 0.57 ) and 0.52 ( 0.38 - 0.65 ) Z-score units . Recovery from underweight and wasting was 20 % and 93 % in LP group and 16 % and 75 % in FS group . Few individuals recovered from stunting and mean length-for-age was not markedly changed . There were no statistically significant differences between the outcomes in the two intervention groups . In a poor food-security setting , underweight infants and children receiving supplementary feeding for 12 weeks with ready-to-use FS or maize-soy flour porridge show similar recovery from moderate wasting and underweight . Neither intervention , if limited to a 12-week duration , appears to have significant impact on the process of linear growth or stunting Objective Maize and soy flour mixes are often used in the treatment of moderate malnutrition in Malawi . Their efficacy has not been formally evaluated . A recently developed ready-to-use food ( RTUF ) effectively promotes growth among severely malnourished children . The authors compared the effect of maize and soy flour with that of RTUF in the home treatment of moderately malnourished children . Methods Sixty-one underweight , stunted children 42 to 60 months of age were recruited in rural Malawi , in southeastern Africa . They received either RTUF or maize and soy flour for 12 weeks . Both supplements provided 2 MJ ( 500Kcal ) of energy daily but had different energy and nutrient densities . Outcome variables were weight and height gain and dietary intake . Results Before intervention , the mean dietary intake and weight and height gain were similar in the two groups . During the supplementation phase , the consumption of staple food fell among children receiving maize and soy flour but not among those receiving RTUF . There was thus higher intake of energy , fat , iron , and zinc in the RTUF group . Both supplements result ed in modest weight gain , but the effect lasted longer after RTUF supplementation . Height gain was not affected in either group . Periodic 24-hour dietary recalls suggested that the children received only 30 % and 43 % , respectively , of the supplementary RTUF and maize and soy flour provided . Conclusions RTUF is an acceptable alternative to maize and soy flour for dietary supplementation of moderately malnourished children . Approaches aim ed at increasing the consumption of supplementary food by the selected recipients are needed Abstract Background : Typical treatment of moderate acute malnutrition , simple wasting , in sub-Saharan Africa consists of dietary counselling and /or general or targeted distribution of corn/soy-blended flour ( CSB ) . A r and omised clinical effectiveness trial in 2007 showed CSB to be less effective than ready-to-use supplementary food ( RUSF ) . Aim : To determine the operational effectiveness of treating moderate acute malnutrition with RUSF . Methods : Children aged 6–59 months were recruited in rural southern Malawi . Each child received 65 kcal/kg/d of locally produced soy/peanut RUSF , a product that provided about 1 RDA of each micronutrient . Anthropometric measurements were taken every 2 weeks and additional rations of RUSF were distributed at this time if the child remained wasted . Study participation lasted up to 8 weeks . Results : Of the 2417 children enrolled , 80 % recovered , 4 % defaulted , 0.4 % died , 12 % remained moderately wasted and 3 % developed severe acute malnutrition . Weight , length and MUAC gain were 2.6 g/kg/d , 0.2 mm/d and 0.1 mm/d respectively . Cost per child treated was $ 5.39 . Conclusions : This intervention proved to be robust , maintaining high recovery rates and low default rates when instituted without the additional supervision and beneficiary incentives of a research setting OBJECTIVE To compare an improved corn-soya blend ( CSB+ ) with a ready-to-use supplementary food ( RUSF ) to test the hypothesis that satisfactory recovery rate will be achieved with CSB+ or RUSF when these foods provide 50 % of the child 's energy requirement , the 50 % remaining coming from usual diet . DESIGN A comparative efficacy trial study was conducted with moderately wasted children , using a controlled r and omized design , with parallel assignment for RUSF or CSB+ . Every child received a daily ration of 167 kJ ( 40 kcal)/kg body weight during 56 d with a follow-up performed every 14 d. Every caregiver received nutrition counselling at enrolment and at each follow-up visit . SETTING Health districts of Mvog-Beti and Evodoula in the Centre region of Cameroon . SUBJECTS Eight hundred and thirty-three children aged 6 - 59 months were screened and eighty-one malnourished children ( weight-for-height Z-score between -3 and -2 ) aged 25 - 59 months were selected . RESULTS Of children treated with CSB+ and RUSF , 73 % ( 95 % CI 59 % , 87 % ) and 85 % ( 95 % CI 73 % , 97 % ) , respectively , recovered from moderate acute malnutrition , with no significant difference between groups . The mean duration of treatment required to achieve recovery was 44 d in the RUSF group and 51 d in the CSB+ group ( log-rank test , P=0·0048 ) . CONCLUSIONS There was no significant difference in recovery rate between the groups . Both CSB+ and RUSF were relatively successful for the treatment of moderate acute malnutrition in children . Despite the relatively low ration size provided , the recovery rates observed for both groups were comparable to or higher than those reported in previous studies , a probable effect of nutrition education Background Globally , Médecins Sans Frontières ( MSF ) treats more than 300,000 severely malnourished children annually . Malnutrition is not only caused by lack of food and poor infant and child feeding practice s but also by illnesses . Breaking the vicious cycle of illness and malnutrition by providing ill children with nutritional supplementation is a potentially powerful strategy for preventing malnutrition that has not been adequately investigated . Therefore , MSF investigated whether incidence of malnutrition among ill children < 5 y old could be reduced by providing a fortified food product or micronutrients during their 2-wk convalescence period . Two trials , one in Nigeria and one in Ug and a , were conducted ; here we report on the trial that took place in Goronyo , a rural region of northwest Nigeria with high morbidity and malnutrition rates . Methods and Findings We investigated the effect of supplementation with ready-to-use therapeutic food ( RUTF ) and a micronutrient powder ( MNP ) on the incidence of malnutrition in ill children presenting at an outpatient clinic in Goronyo during February to September 2012 . A three-armed , partially-blinded , r and omised controlled trial was conducted in children diagnosed as having malaria , diarrhoea , or lower respiratory tract infection . Children aged 6 to 59 mo were r and omised to one of three arms : one sachet/d of RUTF ; two sachets/d of micronutrients or no supplement ( control ) for 14 d for each illness over 6 mo . The primary outcome was the incidence of first negative nutritional outcome ( NNO ) during the 6 mo follow-up . NNO was a study -specific measure used to indicate occurrence of malnutrition ; it was defined as low weight-for-height z-score ( < −2 for non-malnourished and < −3 for moderately malnourished children ) , mid-upper arm circumference < 115 mm , or oedema , whichever came first . Of the 2,213 r and omised participants , 50.0 % were female and the mean age was 20.2 ( st and ard deviation 11.2 ) months ; 160 ( 7.2 % ) were lost to follow-up , 54 ( 2.4 % ) were admitted to hospital , and 29 ( 1.3 % ) died . The incidence rates of NNO for the RUTF , MNP , and control groups were 0.522 ( 95 % confidence interval ( 95 % CI ) , 0.442–0.617 ) , 0.495 ( 0.415–0.589 ) , and 0.566 ( 0.479–0.668 ) first events/y , respectively . The incidence rate ratio was 0.92 ( 95 % CI , 0.74–1.15 ; p = 0.471 ) for RUTF versus control ; 0.87 ( 0.70–1.10 ; p = 0.242 ) for MNP versus control and 1.06 ( 0.84–1.33 , p = 0.642 ) for RUTF versus MNP . A subgroup analysis showed no interaction nor confounding , nor a different effectiveness of supplementation , among children who were moderately malnourished compared with non-malnourished at enrollment . The average number of study illnesses for the RUTF , MNP , and control groups were 4.2 ( 95 % CI , 4.0–4.3 ) , 3.4 ( 3.2–3.6 ) , and 3.6 ( 3.4–3.7 ) . The proportion of children who died in the RUTF , MNP , and control groups were 0.8 % ( 95 % CI , 0.3–1.8 ) , 1.8 % ( 1.0–3.3 ) , and 1.4 % ( 0.7–2.8 ) . Conclusions A 2-wk supplementation with RUTF or MNP to ill children as part of routine primary medical care did not reduce the incidence of malnutrition . The lack of effect in Goronyo may be due to a high frequency of morbidity , which probably further affects a child ’s nutritional status and children ’s ability to escape from the illness – malnutrition cycle . The duration of the supplementation may have been too short or the doses of the supplements may have been too low to mitigate the effects of high morbidity and pre-existing malnutrition . An integrated approach combining prevention and treatment of diseases and treatment of moderate malnutrition , rather than prevention of malnutrition by nutritional supplementation alone , might be more effective in reducing the incidence of acute malnutrition in ill children . Trial Registration clinical trials.gov We tested the possibility to prepare a hyperproteic and hyperenergetic supplementary food for malnutrition rehabilitation in children starting from available ingredients in popular markets in Sierra Leone . Twelve residents in Paediatrics from University of Parma , Italy , prepared in a hospital near the capital Freetown with modest technology a mixture of peanut flour , palm oil , milk powder , sugar and vitamins to which they gave the name of " Parma pap " . Three hundred and thirty-two malnourished children ( mean age 14±6.3 months ) who were receiving Feeding Program Supplementations ( FPS ) , were enrolled in the study : 177 participants received r and omly FSP portions only ( Group 1 ) , and 159 participants were treated with FSP regimen plus a supplement of " Parma pap " ( Group 2 ) . Outcomes of the study were computed as WHZ-score increment ( Δ value ) by subtracting the discharge WHZ-score from the admission WHZ-score . The best Δ-WHZ-scores ( > + 4 ) were recorded among participants of Group 2 ( 64 % ) rather than in Group 1 ( 21 % ; p=0.040 ) . The children receiving FSP portions plus " Parma pap "  recovered faster ( 5.54 week on average ) than those treated with FSP regimen only ( 8.16 on average ) . The percentage of children who did not recover was higher in Group 1 ( 25.3 % ) than in Group 2 (; 13 % ; p=0.05 ) . A slight positive correlation has been found between WHZ-scores at admission and at the end of the study ( r=0.19 ; p=0.045 ) . During the experience in Sierra Leone we have had the chance to give " Parma pap " to twenty one malnourished children admitted to Xaverian Mission in Makeni , northern Sierra Leone , not taking other supplementary food . Sixteen of these children recovered in 4.9 week on average and five in 6 to 8 weeks . Mean Δ-WHZ-scores ranged between + 1 and + 5 . The data from the present study suggest that " Parma pap " could be an effective additional food to FPS regimen in malnutrition recovering . Further research es are needed on the contrary to prove if " Parma pap " could be defined as a veritable ready to use therapeutic food , although this characteristic seems already to result from the experience in Makeni Mission BACKGROUND Children with moderate acute malnutrition ( MAM ) are often treated with fortified blended flours , most commonly a corn-soy blend ( CSB ) . However , recovery rates remain < 75 % , lower than the rate achieved with peanut paste-based ready-to-use supplementary foods ( RUSFs ) . To bridge this gap , a novel CSB recipe fortified with oil and dry skim milk , " CSB++ , " has been developed . OBJECTIVE In this trial we compared CSB++ with 2 RUSF products for the treatment of MAM to test the hypothesis that the recovery rate achieved with CSB++ will not be > 5 % worse than that achieved with either RUSF . DESIGN We conducted a prospect i ve , r and omized , investigator-blinded , controlled noninferiority trial involving rural Malawian children aged 6 - 59 mo with MAM . Children received 75 kcal CSB++ · kg(-1 ) · d(-1 ) , locally produced soy RUSF , or an imported soy/whey RUSF for ≤12 wk . RESULTS The recovery rate  for CSB++ ( n = 763 of 888 ; 85.9 % ) was similar to that for soy RUSF ( 795 of 806 , 87.7 % ; risk difference : -1.82 % ; 95 % CI : -4.95 % , 1.30 % ) and soy/whey RUSF ( 807 of 918 , 87.9 % ; risk difference : -1.99 % ; 95 % CI : -5.10 % , 1.13 % ) . On average , children who received CSB++ required 2 d longer to recover , and the rate of weight gain was less than that with either RUSF , although height gain was the same among all 3 foods studied . CONCLUSIONS A novel , locally produced , fortified blended flour ( CSB++ ) was not inferior to a locally produced soy RUSF and an imported soy/whey RUSF in facilitating recovery from MAM . The recovery rate observed for CSB++ was higher than that for any other fortified blended flour tested previously . This trial is registered at clinical trials.gov as NCT00998517 This prospect i ve r and omized trial was carried out to test the efficacy of a specific intervention for reducing the extent of their malnutrition and to change behaviour of mothers relating to child-feeding practice s , care-giving , and health-seeking practice s under the Bangladesh Integrated Nutrition Project ( BINP ) . The study was conducted in rural Bangladesh among 282 moderately-malnourished ( weight-for-age between 61 % and 75 % of median of the National Center for Health Statistics st and ard ) children aged 6 - 24 months . Mothers of the first intervention group received intensive nutrition education ( INE group ) twice a week for three months . The second intervention group received the same nutrition education , and their children received additional supplementary feeding ( INE+SF group ) . The comparison group received nutrition education from the community nutrition promoters twice a month according to the st and ard routine service of BINP . The children were observed for a further six months . After three months of interventions , a significantly higher proportion of children in the INE and INE+SF groups improved ( 37 % and 47 % respectively ) from moderate to mild or normal nutrition compared to the comparison group ( 18 % ) ( p < 0.001 ) . At the end of six months of observation , the nutritional status of children in the intervention groups improved further from moderate to mild or normal nutrition compared to the comparison group ( 59 % and 86 % vs 30 % , p < 0.0001 ) . As the intensive nutrition education and supplementation given were highly effective , more children improved from moderate malnutrition to mild or normal nutritional status despite a higher incidence of morbidity . The frequency of child feeding and home-based complementary feeding improved significantly ( p < 0.001 ) in both the intervention groups after three months of interventions and six months of observation . Body-weight gain was positively associated with age , length-for-age , weight-for-length , frequency of feeding of khichuri , egg , and potato ( p < 0.05 ) . Ability of mothers to identify malnutrition improved from 15 % to 99 % in the INE group and from 15 % to 100 % in the INE+SF group , but reduced from 24 % to 21 % in the comparison group . Use of separate feed pots , frequency of feeding , and cooking of additional complementary feeds improved significantly in the INE and INE+SF groups compared to the comparison group after three months of interventions and six months of observation . It can be concluded from the findings of the study that intensive nutrition education significantly improves the status of moderately-malnourished children with or without supplementary feeding Objective : Fortified spreads ( FSs ) have proven effective in the rehabilitation of severely malnourished children . We examined acceptability , growth and change in blood haemoglobin ( Hb ) concentration among moderately underweight ambulatory infants given FS . Methods : This was a r and omised , controlled , parallel-group , investigator-blind clinical trial in rural Malawi . Six- to 17-month-old underweight infants ( weight for age < −2 ) , whose weight was greater than 5.5 kg and weight-for-height z score greater than −3 received for 12 weeks at home 1 of 8 food supplementation schemes : nothing , 5 , 25 , 50 , or 75 g/day milk-based FS or 25 , 50 , or 75 g/day soy-based FS . Outcome measures included change in weight , length and blood Hb concentration . Results : A total of 126 infants started and 125 completed the intervention . All infants accepted the spread well , and no intolerance was recorded . Average weight and length gains were higher among infants receiving daily 25 to 75 g FS than among those receiving only 0 to 5 g FS . Mean Hb concentration remained unchanged among unsupplemented controls but increased by 10 to 17 g/L among infants receiving any FS . All average gains were largest among infants receiving 50 g of FS daily : mean difference ( 95 % confidence interval ) in the 12-week gain between infants in 50 g milk-based FS group and the unsupplemented group was 290 g ( range , −130 to 700 g ) , 0.9 cm ( range , −0.3 to 2.2 cm ) , and 17 g/L ( range , 0 to 34 g/L ) for weight , length and blood Hb concentration , respectively . In soy- vs milk-based FS groups , average outcomes were comparable . Conclusions : Supplementation with 25 to 75 g/day of highly fortified spread is feasible and may promote growth and alleviate anaemia among moderately malnourished infants . Further trials should test this hypothesis Moderate acute malnutrition ( MAM ) affects 11 % of children < 5 y old worldwide and increases their risk for morbidity and mortality . It is assumed that successful treatment of MAM reduces these risks . A total of 1967 children aged 6 - 59 mo successfully treated for MAM in rural Malawi following r and omized treatment with corn-soy blend plus milk and oil ( CSB++ ) , soy ready-to-use supplementary food ( RUSF ) , or soy/whey RUSF were followed for 12 mo . The initial supplementary food was given until the child reached a weight-for-height Z-score ( WHZ ) > -2 . The median duration of feeding was 2 wk , with a maximum of 12 wk . The hypothesis tested was that children treated with either RUSF would be more likely to remain well-nourished than those treated with CSB++ . The primary outcome , remaining well-nourished , was defined as mid-upper arm circumference ≥12.5 cm or WHZ ≥-2 for the entire duration of follow-up . During the 12-mo follow-up period , only 1230 ( 63 % ) children remained well-nourished , 334 ( 17 % ) relapsed to MAM , 190 ( 10 % ) developed severe acute malnutrition , 74 ( 4 % ) died , and 139 ( 7 % ) were lost to follow-up . Children who were treated with soy/whey RUSF were more likely to remain well-nourished ( 67 % ) than those treated with CSB++ ( 62 % ) or soy RUSF ( 59 % ) ( P = 0.01 ) . A seasonal pattern of food insecurity and adverse clinical outcomes was observed . This study demonstrates that children successfully treated for MAM with soy/whey RUSF are more likely to remain well-nourished ; however , all children successfully treated for MAM remain vulnerable
Background Moderate acute malnutrition is a major public health problem affecting children from low- and middle-income countries .
Lipid nutrient supplements have been proposed as a nutritional intervention for its treatment .
Objectives To evaluate the effectiveness and safety of  LNS  for the treatment of MAM in infants and children 6 to 59 months of age .