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 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. 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 Home-Based Treatment of Malnourished Malawian Children with Locally Produced or Imported Ready-to-Use Food 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. Nutrition rehabilitation of undernourished children utilizing Spiruline and Misola 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. 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 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 a Low-Cost Food on the Recovery and Death Rate of Malnourished Children Growth and Change in Blood Haemoglobin Concentration Among Underweight Malawian Infants Receiving Fortified Spreads for 12 Weeks: A Preliminary Trial A ready-to-use therapeutic food containing 10% milk is less effective than one with 25% milk in the treatment of severely malnourished children.
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 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 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 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 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 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 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 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 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 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 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 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 Malnourished children have a higher risk of death and illness .
Treating severe acute malnourished children in hospitals is not always desirable or practical in rural setting s , and home treatment may be better .
Home treatment can be food prepared by the carer , such as flour porridge , or commercially manufactured food such as ready-to-use therapeutic food ( RUTF ) .
RUTF is made according to a st and ard , energy-rich composition defined by the World Health Organization ( WHO ) .
The benefits of RUTF include a low moisture content , long shelf life without needing refrigeration and that it requires no preparation .
OBJECTIVES To assess the effects of home-based RUTF on recovery , relapse and mortality in children with severe acute malnutrition .