Low‐dose RUTF protocol and improved service delivery lead to good programme outcomes in the treatment of uncomplicated SAM: a programme report from Myanmar Ready-to-use therapeutic food with elevated n-3 polyunsaturated fatty acid content, with or without fish oil, to treat severe acute malnutrition: a randomized controlled trial Could nutritional rehabilitation at home complement or replace centre-based therapeutic feeding programmes for severe malnutrition? Effect of the consumption of high energy dense and fortified gruels on energy and nutrient intakes of 6–10-month-old Vietnamese infants AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both Costing of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition from a randomised trial in India 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. Spread fortified with vitamins and minerals induces catch-up growth and eradicates severe anemia in stunted refugee children aged 3-6 y. 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. Effect of ready-to-use supplementary food on mortality in severely immunocompromised HIV-infected individuals in Africa initiating antiretroviral therapy (REALITY): an open-label, parallel-group, randomised controlled trial Home‐based therapy with ready‐to‐use therapeutic food is of benefit to malnourished, HIV‐infected Malawian children Home based therapy for severe malnutrition with ready-to-use food Probiotics and prebiotics for severe acute malnutrition (PRONUT study): a double-blind efficacy randomised controlled trial in Malawi Acceptability of Two Ready-to-Use Therapeutic Foods by HIV-Positive Patients in Vietnam Home-Based Treatment of Malnourished Malawian Children with Locally Produced or Imported Ready-to-Use Food Treatment outcomes of severe acute malnutrition in children treated within Outpatient Therapeutic Program (OTP) at Wolaita Zone, Southern Ethiopia: retrospective cross-sectional study 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. Acceptability and Efficacy of Locally Produced Ready-to-Use Therapeutic Food Nutreal in the Management of Severe Acute Malnutrition in Comparison With Defined Food Effectiveness of milk whey protein‐based ready‐to‐use therapeutic food in treatment of severe acute malnutrition in Malawian under‐5 children: a randomised, double‐blind, controlled non‐inferiority clinical trial The "ComPAS Trial" combined treatment model for acute malnutrition: study protocol for the economic evaluation Combined Protocol for Acute Malnutrition Study (ComPAS) in rural South Sudan and urban Kenya: study protocol for a randomized controlled trial Nutrition rehabilitation of undernourished children utilizing Spiruline and Misola Effectiveness of indigenous ready-to-use therapeutic food in community-based management of uncomplicated severe acute malnutrition: a randomized controlled trial from India. 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. Comparison of the effectiveness of a milk-free soy-maize-sorghum-based ready-to-use therapeutic food to standard ready-to-use therapeutic food with 25% milk in nutrition management of severely acutely malnourished Zambian children: an equivalence non-blinded cluster randomised controlled trial. Supplementary feeding with fortified spreads results in higher recovery rates than with a corn/soy blend in moderately wasted children. Supplemental feeding with ready-to-use therapeutic food in Malawian children at risk of malnutrition. 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 WHO/UNICEF recommended therapeutic food versus home based therapeutic food in the management of severe acute malnutrition: A randomized controlled trial. 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. Effect of preventive supplementation with ready-to-use therapeutic food on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger: a cluster randomized trial. Effect of a Low-Cost Food on the Recovery and Death Rate of Malnourished Children High-Oleic Ready-to-Use Therapeutic Food Maintains Docosahexaenoic Acid Status in Severe Malnutrition Growth and Change in Blood Haemoglobin Concentration Among Underweight Malawian Infants Receiving Fortified Spreads for 12 Weeks: A Preliminary Trial Cereals and pulse-based ready-to-use therapeutic food as an alternative to the standard milk- and peanut paste-based formulation for treating severe acute malnutrition: a noninferiority, individually randomized controlled efficacy clinical trial. Enhancing the usability of systematic reviews by improving the consideration and description of interventions Severe and Moderate Acute Malnutrition Can Be Successfully Managed with an Integrated Protocol in Sierra Leone. Effectiveness of a Locally Produced, Fish-Based Food Product on Weight Gain among Cambodian Children in the Treatment of Acute Malnutrition: A Randomized Controlled Trial Amino-acid-enriched cereals ready-to-use therapeutic foods (RUTF) are as effective as milk-based RUTF in recovering essential amino acid during the treatment of severe acute malnutrition in children: An individually randomized control trial in Malawi A ready-to-use therapeutic food containing 10% milk is less effective than one with 25% milk in the treatment of severely malnourished children.
Abstract The treatment of uncomplicated severe acute malnutrition ( SAM ) requires substantial amounts of ready‐to‐use therapeutic food ( RUTF ) . In 2009 , Action Contre la F aim anticipated a shortfall of RUTF for their nutrition programme in Myanmar . A low‐dose RUTF protocol to treat children with uncomplicated SAM was adopted . In this protocol , RUTF was dosed according to beneficiary 's body weight , until the child reached a Weight‐for‐Height z‐score of ≥−3 and mid‐upper arm circumference ≥110 mm . From this point , the child received a fixed quantity of RUTF per day , independent of body weight until discharge . Specific measures were implemented as part of this low‐dose RUTF protocol in order to improve service quality and beneficiary support . We analysed individual records of 3083 children treated from July 2009 to January 2010 . Up to 90.2 % of children recovered , 2.0 % defaulted and 0.9 % were classified as non‐responders . No deaths were recorded . Among children who recovered , median [ IQR ] length of stay and weight gain were 42 days [ 28 ; 56 ] and 4.0 g kg–1 day–1 [ 3.0 ; 5.7 ] , respectively . Multivariable logistic regression showed that children older than 48 months had higher odds of non‐response to treatment than younger children ( adjusted odds ratio : 3.51 , 95 % CI : 1.67–7.42 ) . Our results indicate that a low‐dose RUTF protocol , combined with specific measures to ensure good service quality and beneficiary support , was successful in treating uncomplicated SAM in this setting . This programmatic experience should be vali date d by r and omised studies aim ing to test , quantify and attribute the effect of the protocol adaptation and programme improvements presented here Background Ready-to-use therapeutic foods ( RUTF ) are lipid-based pastes widely used in the treatment of acute malnutrition . Current specifications for RUTF permit a high n-6 polyunsaturated fatty acid ( PUFA ) content and low n-3 PUFA , with no stipulated requirements for preformed long-chain n-3 PUFA . The objective of this study was to develop an RUTF with elevated short-chain n-3 PUFA and measure its impact , with and without fish oil supplementation , on children ’s PUFA status during treatment of severe acute malnutrition . Methods This r and omized controlled trial in children with severe acute malnutrition in rural Kenya included 60 children aged 6 to 50 months who were r and omized to receive i ) RUTF with st and ard composition ; ii ) RUTF with elevated short chain n-3 PUFA ; or iii ) RUTF with elevated short chain n-3 PUFA plus fish oil capsules . Participants were followed-up for 3 months . The primary outcome was erythrocyte PUFA composition . Results Erythrocyte docosahexaenoic acid ( DHA ) content declined from baseline in the two arms not receiving fish oil . Erythrocyte long-chain n-3 PUFA content following treatment was significantly higher for participants in the arm receiving fish oil than for those in the arms receiving RUTF with elevated short chain n-3 PUFA or st and ard RUTF alone : 3 months after enrolment , DHA content was 6.3 % ( interquartile range 6.0–7.3 ) , 4.5 % ( 3.9–4.9 ) , and 3.9 % ( 2.4–5.7 ) of total erythrocyte fatty acids ( P < 0.001 ) , respectively , while eicosapentaenoic acid ( EPA ) content was 2.0 % ( 1.5–2.6 ) , 0.7 % ( 0.6–0.8 ) , and 0.4 % ( 0.3–0.5 ) ( P < 0.001 ) . RUTF with elevated short chain n-3 PUFA and fish oil capsules were acceptable to participants and carers , and there were no significant differences in safety outcomes . Conclusions PUFA requirements of children with SAM are not met by current formulations of RUTF , or by an RUTF with elevated short-chain n-3 PUFA without additional preformed long-chain n-3 PUFA . Clinical and growth implication s of revised formulations need to be addressed in large clinical trials . Trial registration Clinical trials.gov NCT01593969 . Registered 4 May 2012 To measure the success rate of three different strategies used in Médecins Sans Frontières large-scale therapeutic nutritional rehabilitation programme in Niger , we analysed three cohorts of severely malnourished patients in terms of daily weight gain , length of stay , recovery , case fatality and defaulting . A total of 1937 children aged 6 - 59 months were followed prospect ively from 15 August 2002 to 21 October 2003 . For the three cohorts , 660 children were maintained in the therapeutic feeding centre ( TFC ) during the entire treatment , 937 children were initially treated at the TFC and completed treatment at home and 340 children were exclusively treated at home . For all cohorts , average time in the programme and average weight gain met the international st and ards ( 30 - 40 days , > 8 g/kg/day ) . Default rates were 28.1 , 16.8 and 5.6 % for TFC only , TFC plus home-based and home-based alone strategies , respectively . The overall case fatality rate for the entire programme was 6.8 % . Case fatality rates were 18.9 % for TFC only and 1.7 % for home-based alone . No deaths were recorded in children transferred to rehabilitation at home . This study suggests that satisfactory results for the treatment of severe malnutrition can be achieved using a combination of home and hospital-based strategies The aim of this study was to test the ability of two new products , an instant infant flour and a food supplement containing amylases , to increase energy and micronutrient intakes of infants older than 6 months . Three groups of 48 infants were r and omly constituted . Infants in groups 1 and 2 consumed at least twice a day gruel made either from the instant flour or from the food supplement . Infants from the control group received complementary foods prepared in the usual way . Each infant was surveyed during a whole day in order to measure feeding frequencies and characteristics as well as amounts of the different types of complementary foods consumed . Foods consumed by infants in the two experimental groups differed considerably in energy , micronutrient density and in consistency from the home-made complementary foods . Due to the incorporation of amylases , gruels made from the food supplement had a higher energy density , a more appropriate consistency and result ed in higher intakes per meal than gruels made from instant flour . In comparison with home-made complementary foods , both experimental products result ed in significantly higher energy and nutrient intakes . The two experimental products appeared to increase sufficiently both energy and nutrient intakes of infants to complement their breastmilk intake The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions Trial design Three feeding regimens— central ly produced ready-to-use therapeutic food , locally produced ready-to-use therapeutic food , and augmented , energy-dense , home-prepared food — were provided in a community setting for children with severe acute malnutrition ( SAM ) in the age group of 6–59 months in an individually r and omised multicentre trial that enrolled 906 children .  Foods , counselling , feeding support and treatment for mild illnesses were provided until recovery or 16 weeks . Methods Costs were estimated for 371 children enrolled in Delhi in a semiurban location after active survey and identification , enrolment , diagnosis and treatment for mild illnesses , and finally treatment with one of the three regimens , both under the research and government setting . Direct costs were estimated for human re sources using a price times quantity approach , based on their salaries and average time taken for each activity . The cost per week per child for food , medicines and other consumables was estimated based on the total expenditure over the period and children covered . Indirect costs for programme management including training , transport , non-consumables , infrastructure and equipment were estimated per week per child based on total expenditures for research study and making suitable adjustments for estimations under government setting . Results No significant difference in costs was found across the three regimens per covered or per treated child . The average cost per treated child in the government setting was estimated at US$ 56 ( < 3500 rupees ) . Conclusion Home-based management of SAM with a locally produced ready-to-use therapeutic food is feasible , acceptable , affordable and very cost-effective in terms of the disability-adjusted life years saved and gross national income per capita of the country . The treatment of SAM at home needs serious attention and integration into the existing health system , along with actions to prevent SAM . Trial registration number NCT01705769 ; Pre- results 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 Multiple micronutrient deficiencies are often the basic causative factor in stunting and anemia , 2 conditions that affect entire generations of children in deprived population s. No generally accepted recommendations for micronutrient intakes for recovery from stunting are available . OBJECTIVE The objective was to assess the effect of a highly nutrient-dense spread fortified with vitamins and minerals , with or without antiparasitic metronidazole treatment , in correcting retarded linear growth and reducing anemia in stunted children . DESIGN Saharawi refugee children ( n = 374 ) aged 3 - 6 y with initial height-for-age z scores < -2 were assigned to 1 of 5 groups : fortified spread ( FS ) , fortified spread plus metronidazole ( FS+M ) , unfortified spread ( US ) , unfortified spread plus metronidazole ( US+M ) , or control . Supervised supplementation was given daily for 6 mo . Weight , height , knee-heel length , hematologic indexes , parasitic infections , and morbidity were assessed at 0 , 3 , and 6 mo . RESULTS Linear growth of children fed FS was 30 % faster at 3 mo than in US and control groups , after which height-for-age z scores increased only slightly in the FS group and remained unchanged in the other groups . No additional benefits from metronidazole were observed . Increase in hemoglobin concentrations in the FS group at 6 mo was twofold that in the US and control groups ( 37 + /- 40 , 19 + /- 15 , and 16 + /- 17 g/L , respectively ; P < 0.0001 ) , and anemia was reduced by nearly 90 % . CONCLUSIONS FS , and not US , induces catch-up growth in stunted children whose diets are poor in micronutrients . Our trial provides support for delivering multiple micronutrients to reverse stunting and reduce anemia in children up to age 6 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 Summary Background In sub-Saharan Africa , severely immunocompromised HIV-infected individuals have a high risk of mortality during the first few months after starting antiretroviral therapy ( ART ) . We hypothesise that universally providing ready-to-use supplementary food ( RUSF ) would increase early weight gain , thereby reducing early mortality compared with current guidelines recommending ready-to-use therapeutic food ( RUTF ) for severely malnourished individuals only . Methods We did a 2 × 2 × 2 factorial , open-label , parallel-group trial at inpatient and outpatient facilities in eight urban or periurban regional hospitals in Kenya , Malawi , Ug and a , and Zimbabwe . Eligible participants were ART-naive adults and children aged at least 5 years with confirmed HIV infection and a CD4 cell count of fewer than 100 cells per μL , who were initiating ART at the facilities . We r and omly assigned participants ( 1:1 ) to initiate ART either with ( RUSF ) or without ( no-RUSF ) 12 weeks ' of peanut-based RUSF containing 1000 kcal per day and micronutrients , given as two 92 g packets per day for adults and one packet ( 500 kcal per day ) for children aged 5–12 years , regardless of nutritional status . In both groups , individuals received supplementation with RUTF only when severely malnourished ( ie , body-mass index [ BMI ] < 16–18 kg/m2 or BMI -for-age Z scores < –3 for children ) . We did the r and omisation with computer-generated , sequentially numbered tables with different block sizes incorporated within an online data base . R and omisation was stratified by centre , age , and two other factorial r and omisations , to 12 week adjunctive raltegravir and enhanced anti-infection prophylaxis ( reported elsewhere ) . Clinic visits were scheduled at weeks 2 , 4 , 8 , 12 , 18 , 24 , 36 , and 48 , and included nurse assessment of vital status and symptoms and dispensing of all medication including ART and RUSF . The primary outcome was mortality at week 24 , analysed by intention to treat . Secondary outcomes included absolute changes in weight , BMI , and mid-upper-arm circumference ( MUAC ) . Safety was analysed in all r and omly assigned participants . Follow-up was 48 weeks . This trial is registered with Clinical Trials.gov ( NCT01825031 ) and the IS RCT N registry ( 43622374 ) . Findings Between June 18 , 2013 , and April 10 , 2015 , we r and omly assigned 1805 participants to treatment : 897 to RUSF and 908 to no-RUSF . 56 ( 3 % ) were lost-to-follow-up . 96 ( 10·9 % , 95 % CI 9·0–13·1 ) participants allocated to RUSF and 92 ( 10·3 % , 8·5–12·5 ) to no-RUSF died within 24 weeks ( hazard ratio 1·05 , 95 % CI 0·79–1·40 ; log-rank p=0·75 ) , with no evidence of interaction with the other r and omisations ( both p>0·7 ) . Through 48 weeks , adults and adolescents aged 13 years and older in the RUSF group had significantly greater gains in weight , BMI , and MUAC than the no-RUSF group ( p=0·004 , 0·004 , and 0·03 , respectively ) . The most common type of serious adverse event was specific infections , occurring in 90 ( 10 % ) of 897 participants assigned RUSF and 87 ( 10 % ) of 908 assigned no-RUSF . By week 48 , 205 participants had serious adverse events in both groups ( p=0·81 ) , and 181 had grade 4 adverse events in the RUSF group compared with 172 in the non-RUSF group ( p=0·45 ) . Interpretation In severely immunocompromised HIV-infected individuals , providing RUSF universally at ART initiation , compared with providing RUTF to severely malnourished individuals only , improved short-term weight gain but not mortality . A change in policy to provide nutritional supplementation to all severely immunocompromised HIV-infected individuals starting ART is therefore not warranted at present . Funding Joint Global Health Trials Scheme ( UK Medical Research Council , UK Department for International Development , and Wellcome Trust ) Aim : To determine if home‐based nutritional therapy will benefit a significant fraction of malnourished , HIV‐infected Malawian children , and to determine if ready‐to‐use therapeutic food ( RUTF ) is more effective in home‐based nutritional therapy than traditional foods . Methods : 93 HIV‐positive children > 1 y old discharged from the nutrition unit in Blantyre , Malawi were systematic ally allocated to one of three dietary regimens : RUTF , RUTF supplement or blended maize/soy flour . RUTF and maize/soy flour provided 730 kJ·kg−1·d−1 , while the RUTF supplement provided a fixed amount of energy , 2100 kJ/d . These children  did not receive antiretroviral chemotherapy . Children were followed fortnightly . Children completed the study when they reached 100 % weight‐for‐height , relapsed or died . Outcomes were compared using regression modeling to account for differences in the severity of malnutrition between the dietary groups . Results : 52/93 ( 56 % ) of all children reached 100 % weight‐for‐height . Regression modeling found that the children receiving RUTF  gained weight more rapidly and were more likely to reach 100 % weight‐for‐height than the other two dietary groups ( p<0.05 ) Background : The st and ard treatment of severe malnutrition in Malawi often utilises prolonged inpatient care , and after discharge results in high rates of relapse . Aims : To test the hypothesis that the recovery rate , defined as catch-up growth such that weight-for-height z score > 0 ( WHZ , based on initial height ) for ready-to-use food ( RTUF ) is greater than two other home based dietary regimens in the treatment of malnutrition . Methods : HIV negative children > 1 year old discharged from the nutrition unit in Blantyre , Malawi were systematic ally allocated to one of three dietary regimens : RTUF , RTUF supplement , or blended maize/soy flour . RTUF and maize/soy flour provided 730 kJ/kg/day , while the RTUF supplement provided a fixed amount of energy , 2100 kJ/day . Children were followed fortnightly . Children completed the study when they reached WHZ > 0 , relapsed , or died . Outcomes were compared using a time-event model . Results : A total of 282 children were enrolled . Children receiving RTUF were more likely to reach WHZ > 0 than those receiving RTUF supplement or maize/soy flour ( 95 % v 78 % , RR 1.2 , 95 % CI 1.1 to 1.3 ) . The average weight gain was 5.2 g/kg/day in the RTUF group compared to 3.1 g/kg/day for the maize/soy and RTUF supplement groups . Six months later , 96 % of all children that reached WHZ > 0 were not wasted . Conclusions : Home based therapy of malnutrition with RTUF was successful ; further operational work is needed to implement this promising therapy BACKGROUND Severe acute malnutrition affects 13 million children worldwide and causes 1 - 2 million deaths every year . Our aim was to assess the clinical and nutritional efficacy of a probiotic and prebiotic functional food for the treatment of severe acute malnutrition in a HIV-prevalent setting . METHODS We recruited 795 Malawian children ( age range 5 to 168 months [ median 22 , IQR 15 to 32 ] ) from July 12 , 2006 , to March 7 , 2007 , into a double-blind , r and omised , placebo-controlled efficacy trial . For generalisability , all admissions for severe acute malnutrition treatment were eligible for recruitment . After stabilisation with milk feeds , children were r and omly assigned to ready-to-use therapeutic food either with ( n=399 ) or without ( n=396 ) Synbiotic2000 Forte . Average prescribed Synbiotic dose was 10(10 ) colony-forming units or more of lactic acid bacteria per day for the duration of treatment ( median 33 days ) . Primary outcome was nutritional cure ( weight-for-height > 80 % of National Center for Health Statistics median on two consecutive outpatient visits ) . Secondary outcomes included death , weight gain , time to cure , and prevalence of clinical symptoms ( diarrhoea , fever , and respiratory problems ) . Analysis was on an intention-to-treat basis . This trial is registered as an International St and ard R and omised Controlled Trial , number IS RCT N19364765 . FINDINGS Nutritional cure was similar in both Synbiotic and control groups ( 53.9 % [ 215 of 399 ] and 51.3 % [ 203 of 396 ] ; p=0.40 ) . Secondary outcomes were also similar between groups . HIV seropositivity was associated with worse outcomes overall , but did not modify or confound the negative results . Subgroup analyses showed possible trends towards reduced outpatient mortality in the Synbiotic group ( p=0.06 ) . INTERPRETATION In Malawi , Synbiotic2000 Forte did not improve severe acute malnutrition outcomes . The observation of reduced outpatient mortality might be caused by bias , confounding , or chance , but is biologically plausible , has potential for public health impact , and should be explored in future studies . FUNDING Department for International Development ( DfID ) Background : Ready-to-use therapeutic food ( RUTF ) has been found effective in treating severe acute malnutrition . Vietnam ’s National Institute of Nutrition ( NIN ) , the Institut de Recherche pour le Développement ( IRD ) , and UNICEF collaborated to formulate a local RUTF called High-Energy Bar for Integrated Management of Acute Malnutrition ( HEBI ) . RUTF might be useful to address malnutrition in HIV patients . Objective : To compare the acceptability of the local RUTF and an imported RUTF among malnourished people with HIV in Vietnam Methods : The acceptability of HEBI and Plumpy’Nut was studied among 80 HIV-positive children and 80 HIV-positive adults . In a crossover design , participants were r and omly assigned to receive either Plumpy’Nut or HEBI for 2 weeks and were switched to the other product for the subsequent 2 weeks . A third ( control ) group of about 40 HIV-positive participants in each study was r and omly assigned to receive no RUTF . Nurses took anthropometric measurements weekly , and the subjects or their caregivers monitored daily RUTF intake . Results : Children consumed 69 % of HEBI and 65 % of Plumpy’Nut ( p = .13 ) . Adults consumed 91 % of HEBI and 81 % of Plumpy’Nut ( p = .059 ) . Both children ( p = .058 ) and adults ( p ≤ .0001 ) preferred HEBI . Significant gains were observed in percent weight ( p = .035 ) , weight-for-age ( p = .014 ) , and body mass index ( BMI ) -for-age ( p = .036 ) in children who received RUTF and in percent weight ( p = .017 ) and BMI ( p = .0048 ) in adults who received RUTF compared with the control groups . Conclusions : In this study in Vietnam , both HEBI and Plumpy’Nut were found acceptable by people with HIV Objectives : To determine the efficacy of home-based therapy with ready-to-use food ( RTUF ) in producing catch-up growth in  malnourished children and to compare locally produced RTUF with imported RTUF for this purpose . Methods : After a brief inpatient stabilization , 260 children with severe malnutrition were enrolled and systematic ally allocated to receive home therapy with either imported , commercially produced RTUF or locally produced RTUF . Each child received 730 kJ/kg/day and was followed up fortnightly . Children completed the study when they reached a  weight-for-height Z score > −0.5 ( WHZ ) , relapsed , died , or failed to achieve WHZ > −0.5 after 16 weeks . Analyses were stratified by human immunodeficiency virus ( HIV ) status . Results : 78 % of all children reached WHZ > −0.5 , 95 % of those with HIV-negative status and 59 % of those with HIV-positive status . Eighty percent of those receiving locally produced RTUF and 75 % of those receiving imported RTUF reached WHZ > −0.5 . The difference between recovery rates was 5 % ( 95 % confidence interval [ CI ] , −5–15 % ) . The rate of weight gain was 0.4 g/kg/day ( 95 % CI , −0.6 , 1.4 ) greater among children receiving locally produced RTUF . The prevalence of diarrhea reported by mothers was 3.7 % for locally produced RTUF and 4.3 % for imported RTUF . After completion of home therapy and resumption of habitual diet for 6 months , 91 % of all children maintained a normal WHZ . Conclusions : Home-based therapy with RTUF was successful in affecting complete catch-up growth . In this study , locally produced and imported RTUF were similar in efficacy in treating of  severe childhood malnutrition Background Children in third world countries suffer from severe acute malnutrition ( SAM ) in an extent of public health important . SAM management protocol available this time brought the approach from facility-based to community-based by Outpatient Therapeutic Program ( OTP ) . But , little was known about the treatment outcomes of the program in Ethiopia . Thus , this study was aim ed to assess treatment outcomes of SAM and identify factors associated among children treated at OTP in Wolaita Zone . Methods A retrospective facility-based cross-sectional study was conducted in OTP records of 794 children , treated at 24 health posts retrieved from January to December 2014 . Population proportion to size ( PPS ) was used to allocate sample for each selected district and OTP sites within district . Individual cards of children were selected by systematic r and om sampling . Data were entered , thoroughly cleaned , and analyzed in SPSS version 20 . Results The recovery rate was revealed as 64.9 % at 95 % CI ( 61 , 68 ) . Death rate , default rate , weight gain , and length of stay were 1.2 % , 2.2 % , 4.2 g/kg/day , and 6.8 weeks respectively . Children living in < 25 min were with 1.53 times higher odds of recovery than children residing in ≥25 min ( AOR = 1.53 at 95 % CI ( 1.11 , 2.12 ) ) . The likelihood of recovery was 2.6 times higher for children with kwashiorkor than for those with marasmus ( AOR = 2.62 at 95 % CI ( 1.77 , 3.89 ) ) . Likewise , children provided with amoxicillin were 1.52 times more likely to recover compared to their counterparts ( AOR = 1.52 at 95 % CI ( 1.09 , 2.11 ) ) . Conclusions The recovery rate and weight gain were lower than sphere st and ard . Distance from OTP , provision of amoxicillin , and type of malnutrition were factors identified as significantly associated with treatment outcome of SAM . Building capacity of OTP service providers and regular monitoring of service provision based on the management protocol were recommended 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 Background : Severe acute malnutrition ( SAM ) is a salient health problem in India . Federation of Indian Chamber of Commerce and Industry ( FICCI ) Research and Analysis Centre , New Delhi , prepared nutreal equivalent to ready-to-use therapeutic food by World Health Organization ( WHO ) for the management of SAM and defined food like homemade diet . Objective : To compare acceptability and efficacy of nutreal over defined food for the management of SAM . Methods : One hundred twelve children aged less than 5 years with SAM were enrolled as per the st and ard of WHO . Children were r and omized into 2 groups to receive nutreal ( n = 56 ) and defined food ( n = 56 ) in unlimited amounts for 42 consecutive days and extended by 2 weeks as per dem and . Calorie and protein intake , weight , and mid-upper arm circumference ( MUAC ) were recorded daily . Results : Age range was 8 to 45 months . Ninety-three percent of children eagerly accepted nutreal but 7 % does not . Whereas in the defined food group , 68 % accepted eagerly , 30 % did not accept eagerly , and 1.8 % accepted poorly ( P = .004 ) . At enrollment , mean weight in the nutreal group was 6.44 ± 1.60 kg and in the defined food group was 8.69 ± 1.76 kg , with MUAC in the nutreal group being 11.12 ± 0.47 cm and in the defined food group being 11.54 ± 0.34 cm . Mean weight in the nutreal and defined food groups at eighth week of intervention was 7.97 ± 1.8 kg and 9.71 ± 1.8 kg ( P < .001 ) , respectively . Mid-upper arm circumference at eighth week was 12.10 ± 0.29 cm in the nutreal group and 12.49 ± 0.50 cm in the defined group ( P < .001 ) . Conclusion : Acceptability , mean weight gain , and MUAC in the nutreal group are greater than the defined food Abstract The cost of ready‐to‐use therapeutic food ( RUTF ) used in community‐based management of acute malnutrition has been a major obstacle to the scale up of this important child survival strategy . The current st and ard recipe for RUTF [ peanut‐based RUTF ( P‐RUTF ) ] is made from peanut paste , milk powder , oil , sugar , and minerals and vitamins . Milk powder forms about 30 % of the ingredients and may represent over half the cost of the final product . The quality of whey protein concentrates 34 % ( WPC34 ) is similar to that of dried skimmed milk ( DSM ) used in the st and ard recipe and can be 25–33 % cheaper . This blinded , parallel group , r and omised , controlled non‐inferiority clinical trial tested the effectiveness in treating severe acute malnutrition ( SAM ) of a new RUTF formulation WPC‐RUTF in which WPC34 was used to replace DSM . Average weight gain ( non‐inferiority margin Δ = −1.2 g kg−1 day−1 ) and recovery rate ( Δ = −10 % ) were the primary outcomes , and length of stay ( LOS ) was the secondary outcome ( Δ = + 14 days ) . Both per‐ protocol ( PP ) and intention‐to‐treat ( ITT ) analyses showed that WPC‐RUTF was not inferior to P‐RUTF  for recovery rate [ difference and its 95 % confidence interval ( CI ) of 0.5 % ( 95 % CI –2.7 , 3.7 ) in PP analysis and 0.6 % ( 95 % CI –5.2 , 6.3 ) in ITT analysis ] for average weight gain [ 0.2 ( −0.5 ; 0.9 ) for both analyses ] and LOS [ −1.6 days ( 95 % CI , −4.6 , 1.4 days ) in PP analysis and −1.9 days ( 95 % CI , −4.6 , 0.8 days ) for ITT analysis ] . In conclusion , whey protein‐based RUTF is an effective cheaper alternative to the st and ard milk‐based RUTF for the treatment of SAM Background Acute malnutrition is currently divided into severe ( SAM ) and moderate ( MAM ) based on level of wasting . SAM and MAM currently have separate treatment protocol s and products , managed by separate international agencies . For SAM , the dose of treatment is allocated by the child ’s weight . A combined and simplified protocol for SAM and MAM , with a st and ardised dose of ready-to-use therapeutic food ( RUTF ) , is being trialled for non-inferior recovery rates and may be more cost-effective than the current st and ard protocol s for treating SAM and MAM . Method This is the protocol for the economic evaluation of the ComPAS trial , a cluster-r and omised controlled , non-inferiority trial that compares a novel combined protocol for treating uncomplicated acute malnutrition compared to the current st and ard protocol  in South Sudan and Kenya . We will calculate the total economic costs of both protocol s from a societal perspective , using accounting data , interviews and survey question naires . The incremental cost of implementing the combined protocol will be estimated , and all costs and outcomes will be presented as a cost-consequence analysis . Incremental cost-effectiveness ratio will be calculated for primary and secondary outcome , if statistically significant . Discussion We hypothesise that implementing the combined protocol will be cost-effective due to streamlined logistics at clinic level , reduced length of treatment , especially for MAM , and reduced dosages of RUTF . The findings of this economic evaluation will be important for policymakers , especially given the hypothesised non-inferiority of the main health outcomes . The publication of this protocol aims to improve rigour of conduct and transparency of data collection and analysis . It is also intended to promote inclusion of economic evaluation in other nutrition intervention studies , especially for MAM , and improve comparability with other studies .Trial Registration IS RCT N 30393230 , date : 16/03/2017 Background Acute malnutrition is a continuum condition , but severe and moderate forms are treated separately , with different protocol s and therapeutic products , managed by separate United Nations agencies . The Combined Protocol for Acute Malnutrition Study ( ComPAS ) aims to simplify and unify the treatment of uncomplicated severe and moderate acute malnutrition ( SAM and MAM ) for children 6–59 months into one protocol in order to improve the global coverage , quality , continuity of care and cost-effectiveness of acute malnutrition treatment in re source -constrained setting s. Methods / design This study is a multi-site , cluster r and omized non-inferiority trial with 12 clusters in Kenya and 12 clusters in South Sudan . Participants are 3600 children aged 6–59 months with uncomplicated acute malnutrition . This study will evaluate the impact of a simplified and combined protocol for the treatment of SAM and MAM compared to the st and ard protocol , which is the national treatment protocol in each country . We will assess recovery rate as a primary outcome and coverage , defaulting , death , length of stay , average weekly weight gain and average weekly mid-upper arm circumference ( MUAC ) gain as secondary outcomes . Recovery rate is defined across both treatment arms as MUAC ≥125 mm and no oedema for two consecutive visits . Per- protocol and intention-to-treat analyses will be conducted . Discussion If the combined protocol is shown to be non-inferior to the st and ard protocol , updating guidelines to use the combined protocol would eliminate the need for separate products , re sources and procedures for MAM treatment . This would likely be more cost-effective , increase availability of services , enable earlier case finding and treatment before deterioration of MAM into SAM , promote better continuity of care and improve community perceptions of the programme . Trial registration IS RCT N , IS RCT N30393230 . Registered on 16 March 2017 Background Malnutrition constitutes a public health problem throughout the world and particularly in developing countries . Aims The objective of the study is to assess the impact of an elementary integrator composed of Spiruline ( Spirulina platensis ) and Misola ( millet , soja , peanut ) produced at the Centre Medical St Camille ( CMSC ) of Ouagadougou , Burkina Faso , on the nutritional status of undernourished children . Material s and methods 550 undernourished children of less than 5 years old were enrolled in this study , 455 showed severe marasma , 57 marasma of medium severity and 38 kwashiorkor plus marasma . We divided the children r and omly into four groups : 170 were given Misola ( 731 ± 7 kcal/day ) , 170 were given Spiruline plus traditional meals ( 748 ± 6 kcal/day ) , 170 were given Spiruline plus Misola ( 767 ± 5 kcal/day ) . Forty children received only traditional meals ( 722 ± 8 kcal/day ) and functioned as the control group . The duration of this study was eight weeks . Results and Discussion Anthropometrics and haematological parameters allowed us to appreciate both the nutritional and biological evolution of these children . The rehabilitation with Spiruline plus Misola ( this association gave an energy intake of 767 ± 5 kcal/day with a protein assumption of 33.3 ± 1.2 g a day ) , both greater than Misola or Spiruline alone , seems to correct weight loss more quickly . Conclusion Our results indicate that Misola , Spiruline plus traditional meals or Spiruline plus Misola are all a good food supplement for undernourished children , but the rehabilitation by Spiruline plus Misola seems synergically favour the nutrition rehabilitation better than the simple addition of protein and energy intake A r and omized controlled trial was conducted in Ch and igarh , India ( 2011 ) , to determine the effectiveness of indigenous ready-to-use therapeutic food ( RUTF ) in community-based management of uncomplicated severe acute malnutrition ( SAM ) . Intervention was through outpatient therapeutic program site ( OTP ) . Study and control group children ( 6 months-5 years ) were followed up weekly for 12 weeks , in OTP and at home . All children received supplementary nutrition through anganwadis under integrated child development scheme . Study children , in addition , received therapeutic dose of RUTF in OTP . Primary outcome , 115 % of baseline weight , was attained in 6 of 13 ( 46.2 % ) and 1 of 13 ( 7.7 % ) children among study and control group , respectively [ odds ratio : 10.28 , 95 % confidence interval ( CI ) : 1.02 - 103.95 ] . Compared with control group , addition of RUTF in study group result ed in average additional increase in weight by 13 g/kg of baseline weight/week/child ( 95 % CI : 2 - 23 ) . Indigenous RUTF was effective in community-based management of uncomplicated SAM 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 Community-based Management of Acute Malnutrition using ready-to-use therapeutic food ( RUTF ) has revolutionised the treatment of severe acute malnutrition ( SAM ) . However , 25 % milk content in st and ard peanut-based RUTF ( P-RUTF ) makes it too expensive . The effectiveness of milk-free RUTF has not been reported hitherto . This non-blinded , parallel group , cluster r and omised , controlled , equivalence trial that compares the effectiveness of a milk-free soy-maize-sorghum-based RUTF ( SMS-RUTF ) with P-RUTF in treatment of children with SAM , closes the gap . A statistician r and omly assigned health centres ( HC ) either to the  SMS-RUTF ( n = 12 ; 824 enrolled ) or P-RUTF ( n = 12 ; 1103 enrolled ) arms . All SAM children admitted at the participating HCs were enrolled . All the outcomes were measured at individual level . Recovery rate was the primary outcome . The recovery rates for SMS-RUTF and P-RUTF  were 53.3 % and 60.8 % for the intention-to-treat ( ITT ) analysis and 77.9 % and 81.8 % for per protocol ( PP ) analyses , respectively . The corresponding adjusted risk difference ( ARD ) and 95 % confidence interval , were -7.6 % ( -14.9 , 0.6 % ) and -3.5 % ( -9,6 . , 2.7 % ) for ITT ( P = 0.034 ) and PP analyses ( P = 0.257 ) , respectively . An unanticipated interaction ( interaction P < 0.001 for ITT analyses and 0.0683 for PP analyses ) between the study arm and age group was observed . The ARDs were -10.0 ( -17.7 to -2.3)% for ITT ( P = 0.013 ) and -4.7 ( -10.0 to 0.7 ) for PP ( P = 0.083 ) analyses for the < 24 months age group and 2.1 (-10.3,14.6)% for ITT ( P = 0.726 ) and -0.6 ( -16.1 , 14.5 ) for PP ( P = 0.939 ) for the ≥24 months age group . In conclusion , the study did not confirm our hypothesis of equivalence between SMS-RUTF and P-RUTF in SAM management 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 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 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 Malnutrition is a major public health problem especially in the developing countries . The objective of the study was to compare WHO/UNICEF recommended therapeutic food with home based therapeutic food in the management of  severe acute malnutrition . It was a r and omized controlled trial at tertiary care level hospital with nutritional rehabilitation centre . Children ( 6 month to 5 years ) having severe acute malnutrition were included in the study . Group A ( n=74 children ) was given WHO recommended therapeutic food and group B ( n=75 children ) was given home based therapeutic food .  The mean rate of weight gain , gain in height and increase in mid-upper arm circumference were significantly higher ( p<0.05 ) in the group received home based therapeutic food . Mean duration to achieve target weight was 21.44±3.33 days in group A and 16.28±2.11 days in group B ( p < o.ooo1 ) . Group B children had higher rate of increase in urinary creatinine ( p<0.0001 ) . Affordability ( p<0.0001 ) , Feasibility ( p=0.027 ) and Average frequency of feeding per day ( p<0.0001 ) was found significantly higher in group B. Difficulty in making therapeutic food was significantly low in group B ( p<0.05 ) . Both kinds of therapeutic food  were effective for the management of severe acute malnutrition , but the home based therapeutic food was found to be more effective . This could be explained by better acceptability in terms of better palatability , more affordability , increased frequency of feeding , and having less difficulty in making 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 CONTEXT Ready-to-use therapeutic foods ( RUTFs ) are an important component of effective outpatient treatment of severe wasting . However , their effectiveness in the population -based prevention of moderate and severe wasting has not been evaluated . OBJECTIVE To evaluate the effect of a 3-month distribution of RUTF on the nutritional status , mortality , and morbidity of children aged 6 to 60 months in Niger . DESIGN , SETTING , AND PARTICIPANTS A cluster r and omized trial of 12 villages in Maradi , Niger . Six villages were r and omized to intervention and 6 to no intervention . All children in the study villages aged 6 to 60 months were eligible for recruitment . INTERVENTION Children with weight-for-height 80 % or more of the National Center for Health Statistics reference median in the 6 intervention villages received a monthly distribution of 1 packet per day of RUTF ( 92 g [ 500 kcal/d ] ) from August to October 2006 . Children in the 6 nonintervention villages received no preventive supplementation . Active surveillance for conditions requiring medical or nutritional treatment was conducted monthly in all 12 study villages from August 2006 to March 2007 . MAIN OUTCOME MEASURES Changes in weight-for-height z score ( WHZ ) according to the World Health Organization Child Growth St and ards and incidence of wasting ( WHZ < -2 ) over 8 months of follow-up . RESULTS The number of children with height and weight measurements in August , October , December , and February was 3166 , 3110 , 2936 , and 3026 , respectively . The WHZ difference between the intervention and nonintervention groups was -0.10 z ( 95 % confidence interval [ CI ] , -0.23 to 0.03 ) at baseline and 0.12 z ( 95 % CI , 0.02 to 0.21 ) after 8 months of follow-up . The adjusted effect of the intervention on WHZ from baseline to the end of follow-up was thus 0.22 z ( 95 % CI , 0.13 to 0.30 ) . The absolute rate of wasting and severe wasting , respectively , was 0.17 events per child-year ( 140 events/841 child-years ) and 0.03 events per child-year ( 29 events/943 child-years ) in the intervention villages , compared with 0.26 events per child-year ( 233 events/895 child-years ) and 0.07 events per child-year ( 71 events/1029 child-years ) in the nonintervention villages . The intervention thus result ed in a 36 % ( 95 % CI , 17 % to 50 % ; P < .001 ) reduction in the incidence of wasting and a 58 % ( 95 % CI , 43 % to 68 % ; P < .001 ) reduction in the incidence of severe wasting . There was no reduction in mortality , with a mortality rate of 0.007 deaths per child-year ( 7 deaths/986 child-years ) in the intervention villages and 0.016 deaths per child-year ( 18 deaths/1099 child-years ) in the nonintervention villages ( adjusted hazard ratio , 0.51 ; 95 % CI , 0.25 to 1.05 ) . CONCLUSION Short-term supplementation of nonmalnourished children with RUTF reduced the decline in WHZ and the incidence of wasting and severe wasting over 8 months . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00682708 Objectives : Nutritional rehabilitation in Africa relies mainly on imported skim milk enriched with a sugar and salt mixture . We evaluated whether milk plus porridge made from local ingredients improves the outcome of childhood nutritional rehabilitation versus milk alone . Patients and Methods : This study was conducted in a nutritional unit in Lacor ( Northern Ug and a ) . The porridge , made from cheap locally available ingredients ( maize flour , dried fish or meat , peanut butter and oil ) supplemented with proteins and fats , provides 1.1 energy units , 4.4 kJ/g . We r and omly sample d the files of 100 cases discharged in October , November and December 2001 ( preintervention ) , in 2002 ( soon after intervention onset ) and in 2003 ( more than 1 year after intervention onset ) . We recorded the average hospital days and average oedema-free weight gain at discharge in the 3 groups . Results : Average oedema-free weight gain increased from 21 g/d ( 95 % confidence interval [ CI ] , 12 - 29 ) in 2001 to 35 g/d ( 95 % CI , 25 - 45 ) in 2002 and reached 59 g/d ( 95 % CI , 51 - 65 ) in 2003 . Mortality decreased from 22 % to 7.8 % , and nutritional failures ( insufficient weight gain ) decreased by greater than 50 % . Conclusions : The low-cost porridge supplement ( & U20AC;2640/yr per 100 children ) was effective in treating malnutrition . Widespread use of the porridge , which result ed in better outcomes than milk alone , could produce a savings in the medium- to long-term , thereby releasing re sources for other uses . A high-energy porridge that is made from locally available ingredients and does not require imported foods seems to be appropriate for supplementary feeding after mother 's milk in this setting Objectives : Ready-to-use therapeutic food ( RUTF ) is the preferred treatment for uncomplicated severe acute malnutrition . It contains large amounts of linoleic acid and little & agr;-linolenic acid , which may reduce the availability of docosahexaenoic acid ( DHA ) and eicosapentaenoic acid ( EPA ) to the recovering child . A novel high-oleic RUTF ( HO-RUTF ) was developed with less linoleic acid to determine its effect on DHA and EPA status . Methods : We conducted a prospect i ve , r and omized , double-blind clinical effectiveness trial treating rural Malawian children with severe acute malnutrition . Children were treated with either HO-RUTF or st and ard RUTF .  Plasma phospholipid fatty acid status was measured on enrollment and after 4 weeks and compared between the 2 intervention groups . Results : Among the 141 children enrolled , 48 of 71 receiving HO-RUTF and 50 of 70 receiving RUTF recovered .  Plasma phospholipid sample s were analyzed from 43 children consuming HO-RUTF and 35 children consuming RUTF . The change in DHA content during the first 4 weeks was + 4 % and −25 % in the HO-RUTF and RUTF groups , respectively ( P = 0.04 ) . For EPA , the change in content was 63 % and −24 % in the HO-RUTF and RUTF groups , respectively ( P < 0.001 ) . For arachidonic acid , the change in content was −3 % and 13 % in the HO-RUTF and RUTF groups , respectively ( P < 0.009 ) . Conclusions : The changes in DHA and EPA seen in the children treated with HO-RUTF warrant further investigation because they suggest that HO-RUTF support improved polyunsaturated fatty acid status , necessary for neural development and recovery 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 BACKGROUND The cost of current st and ard ready-to-use therapeutic food ( RUTF ) is among the major obstacles to scaling up community-based management of acute malnutrition ( CMAM ) , an important child survival strategy . Identifying a cheaper alternative is a global public health priority . OBJECTIVE We sought to compare the efficacy of soya-maize-sorghum RUTF ( SMS-RUTF ) with that of st and ard peanut paste-based RUTF ( P-RUTF ) . DESIGN We used a nonblinded , parallel-group , simple r and omized controlled trial along with a day care approach that enrolled 2 groups of children aged 6 - 23 and 24 - 59 mo , respectively , with severe acute malnutrition ( SAM ) . RESULTS Intention-to-treat ( ITT ) and per- protocol ( PP ) analyses showed noninferiority of SMS-RUTF compared with P-RUTF for the recovery rate [ ITT : Δ = -2.0 % ( 95 % CI : -7.6 % , 3.6 % ) ; PP : -1.9 % ( 95 % CI : -5.3 % , 1.4 % ) ] , weight gain [ Δ = -0.7 g · kg(-1 ) · d(-1)(95 % CI : -1.3 , 0.0 g · kg(-1 ) · d(-1 ) ) ] , and length of stay [ Δ = 2.0 d ( 95 % CI : -1.7 , 5.8 d ) ] in children ≥24 mo of age . In children ≤23 mo of age , the recovery rate of SMS-RUTF was inferior to that of P-RUTF [ ITT : Δ = -20.8 % ( 95 % CI : -29.9 % , -11.7 % ) ; PP : -17.2 % ( 95 % CI : -25.6 % , -8.7 % ) ] . Treatment with SMS-RUTF result ed in a greater increase in hemoglobin [ 0.670 g/dL ( 95 % CI : 0.420 , 0.921 g/dL);P < 0.001 ] . Treatment with both RUTFs result ed in the replenishment of all of the amino acids tested except for methionine . There were no differences at discharge between RUTF groups in fat mass [ Δ = 0.3 kg ( 95 % CI : -0.6 , 1.6 kg);P= 0.341 ] or fat mass index [ Δ = 0.4 kg/m(2)(95 % CI : -0.3 , 1.1 kg/m(2));P= 0.262 ] . By contrast , comparisons of fat-free mass indicated lower concentrations than the community controls after treatment with either of the 2 RUTFs [ Δ = -1.3 kg ( 95 % CI : -2.4 , -0.1 kg ) and P= 0.034 for comparison between community controls and the SMS-RUTF group ; Δ = -1.8 kg ( 95 % CI : -2.9 , -0.6 kg ) and P= 0.003 for comparison between community controls and the P-RUTF group ] . CONCLUSION SMS-RUTF can be used to treat SAM in children aged ≥24 mo to reduce the costs of CMAM programs . More research is required to optimize SMS-RUTF for younger children . This trial was registered in the Pan African Clinical Trial Registry as PACTR201303000475166 The importance of adequate intervention descriptions in minimising research waste and improving research usability and reproducibility has gained attention in the past few years . Nearly all focus to date has been on intervention reporting in r and omised trials . Yet clinicians are encouraged to use systematic review s , whenever available , rather than single trials to inform their practice . This article explores the problem and implication s of incomplete intervention details during the planning , conduct , and reporting of systematic review s and makes recommendations for review authors , peer review ers , and journal BACKGROUND Global acute malnutrition ( GAM ) is the sum of moderate acute malnutrition ( MAM ) and severe acute malnutrition ( SAM ) . The use of different foods and protocol s for MAM and SAM treatment can be cumbersome in emergency setting s. OBJECTIVE Our objective was to determine the recovery and coverage rates for GAM of an integrated protocol with a single food product , ready-to-use therapeutic food ( RUTF ) , compared with st and ard management . METHODS This was a cluster-r and omized controlled trial in Sierra Leone conducted in 10 centers treating GAM in children aged 6 - 59 mo . The integrated protocol used midupper arm circumference ( MUAC ) as the criterion for admission and discharge , with a MUAC < 12.5 cm defining malnutrition . The protocol included a decreasing ration of RUTF and health maintenance messages delivered by peers . St and ard therapy treated MAM with a fortified blended flour and SAM with RUTF and used weight-for-height to determine admission to the treatment program . Coverage rates were the number of children who received treatment/number of children in the community eligible for treatment . RESULTS Most of the children receiving integrated management had MAM ( 774 of 1100 ; 70 % ) , whereas among those receiving st and ard management , SAM predominated ( 537 of 857 ; 63 % ; P = 0.0001 ) . Coverage was 71 % in the communities served by integrated management and 55 % in the communities served by st and ard care ( P = 0.0005 ) . GAM recovery in the integrated management protocol was 910 of 1100 ( 83 % ) children and was 682 of 857 ( 79 % ) children in the st and ard therapy protocol . CONCLUSION Integrated management of GAM in children is an acceptable alternative to st and ard management and provides greater community coverage . This trial was registered at clinical trials.gov as NCT01785680 Cambodia continues to have a high prevalence of acute malnutrition . Low acceptability has been found for st and ard ready-to-use-therapeutic-food ( RUTF ) products . Therefore , NumTrey , a locally-produced fish-based RUTF , was developed . The objective was to evaluate the effectiveness of NumTrey compared to an imported milk-based RUTF for weight gain  among children aged 6–59 months in the home-treatment for acute malnutrition . Effectiveness was tested in a single-blinded r and omized controlled trial with weight gain as the primary outcome . Anthropometry was assessed at baseline and bi-weekly follow-ups until endline at Week 8 . In total , 121 patients were r and omized into BP-100TM ( n = 61 ) or NumTrey ( n = 60 ) . There was no statistical difference in mean weight gain between the groups ( 1.06 g/kg/day ; 95 % CI ( 0.72 , 1.41 ) and 1.08 g/kg/day ; 95 % CI ( 0.75 , 1.41 ) for BP-100 ™ and NumTrey , respectively ) . In addition , no statistically significant differences in secondary outcomes were found . Although the ability to draw conclusions was limited by lower weight gain than the desired 4 g/kg/day in both groups , no superiority was found for eitherRUTF . A locally produced RUTF is highly relevant to improve nutrition interventions in Cambodia . A locally produced fish-based RUTF is a relevant alternative to imported milk-based RUTF for the treatment of SAM in Cambodia Background Ready-to-use therapeutic food ( RUTF ) is used to treat children suffering from severe acute malnutrition ( SAM ) . St and ard RUTF uses milk as the primary protein source , which makes the product expensive , and given the high worldwide SAM burden , having a less expensive effective alternative is a public health priority . Objective The objective of this study was to evaluate whether newly developed amino acid-enriched milk-free RUTF ( FSMS-RUTF ) or amino acid-enriched low-milk RUTF ( MSMS-RUTF ) treatment could replenish plasma amino acids to levels comparable to those following st and ard peanut-milk RUTF ( PM-RUTF ) treatment and to improve underst and ing of the effects of treatment on anthropometric measurements . A secondary analysis was performed to test the noninferiority hypothesis of plasma essential amino acid ( EAA ) levels . Methods Plasma EAA levels were measured in a nonblinded , 3-arm , parallel-group simple r and omized controlled trial conducted in Malawi to examine the efficacy of FSMS-RUTF , MSMS-RUTF and PM-RUTF in the treatment of SAM in 2 groups of children aged 6–23 and 24–59 months ( mo ) . Sample size calculations were performed based on the previous our study . A noninferiority margin was set at -25 % of the PM-RUTF arm at discharge . Results The relative values of the differences ( 95 % CI ) in plasma EAA levels between PM-RUTF treatment and FSMS-RUTF and MSMS-RUTF treatments at discharge were -7.9 % ( -18.6 , 2.8 ) and 9.8 % ( 0.2 , 19.5 ) , respectively , in children aged 6–23 mo , while in those aged 24–59 mo , the difference values were 17.8 % ( 1.6 , 34.1 ) and 13.6 % ( -2.8 , 29.9 ) , respectively . Conclusion At discharge , the plasma EAA concentrations in 6 - 59-mo-old SAM children treated with FSMS-RUTF and MSMS-RUTF were not less than those of children treated with PM-RUTF . These findings indicate that treatment with either of the 3 RUTFs was associated with adequate protein synthesis and that all the formulations provided sufficient functional metabolites of plasma amino acids to support nutritional recovery from SAM St and ard therapy for severe acute malnutrition ( SAM ) is home-based therapy with ready-to-use therapeutic food ( RUTF ) containing 25 % milk . In an effort to lower the cost of RUTF and increase availability , some have suggested that a portion of milk be replaced with soy . This trial was design ed to determine whether treating children with SAM with 10 % milk RUTF containing soy would result in a similar recovery rate compared with the 25 % milk RUTF . This was a r and omized , double-blind , controlled , clinical , quasi-effectiveness trial of isoenergetic amounts of 2 locally produced RUTF to treat SAM in Malawi among children aged 6 - 59 mo . A total of 1874 children were enrolled . Children were assessed every fortnight and participated in the study until they clinical ly recovered or received 8 wk of treatment . The primary outcome was recovery ( weight-for-height Z score > -2 and no edema ) . Secondary outcomes were rates of weight and height gain . Survival analysis was used to compare the recovery rates . Recovery among children receiving 25 % milk RUTF was greater than children receiving 10 % milk RUTF , 64 % compared with 57 % after 4 wk , and 84 % compared with 81 % after 8 wk ( P < 0.001 ) . Children receiving 25 % milk RUTF also had higher rates of weight and height gain compared with children receiving 10 % milk RUTF . Treating children with SAM with 10 % milk RUTF is less effective compared with treatment with the st and ard 25 % milk RUTF . These findings also emphasize that clinical evidence should be examined before recommending any changes to the formulation of RUTF
BACKGROUND Management of severe acute malnutrition ( SAM ) in children comprises two potential phases : stabilisation and rehabilitation .
During the initial stabilisation phase , children receive treatment for dehydration , electrolyte imbalances , intercurrent infections and other complications .
In the rehabilitation phase ( applicable to children presenting with uncomplicated SAM or those with complicated SAM after complications have been resolved ) , catch-up growth is the main focus and the recommended energy and protein requirements are much higher .
In-hospital rehabilitation of children with SAM is not always desirable or practical - especially in rural setting s - and home-based care can offer a better solution .
Ready-to-use therapeutic food ( RUTF ) is a widely used option for home-based rehabilitation , but the findings of our previous review were inconclusive .
OBJECTIVES To assess the effects of home-based RUTF used during the rehabilitation phase of SAM in children aged between six months and five years on recovery , relapse , mortality and rate of weight gain .