Match!

Body composition during outpatient treatment of severe acute malnutrition: Results from a randomised trial testing different doses of ready-to-use therapeutic foods.

Published on Mar 6, 2020in Clinical Nutrition6.402
· DOI :10.1016/J.CLNU.2020.02.038
Suvi T. Kangas (UCPH: University of Copenhagen), Suvi T. Kangas1
Estimated H-index: 1
+ 6 AuthorsJonathan C. K. Wells62
Estimated H-index: 62
Abstract
Summary Background & aims Treatment of children with uncomplicated severe acute malnutrition (SAM) is based on ready-to-use therapeutic foods (RUTF) prescribed based on body weight and administered at home. Treatment performance is typically monitored through weight gain. We previously reported that a reduced dose of RUTF resulted in weight gain velocity similar to standard dose. Here we investigate the change in body composition of children treated for SAM and compare it to community controls, and describe the effect of a reduced RUTF dose on body composition at recovery. Methods Body composition was measured via bio-electrical impedance analysis at admission and recovery among a sub-group of children with SAM participating in a clinical trial and receiving a reduced or a standard dose of RUTF. Non-malnourished children were measured to represent community controls. Linear mixed regression models were fitted. Results We obtained body composition data from 452 children at admission, 259 at recovery and 97 community controls. During SAM treatment the average weight increased by 1.20 kg of which 0.55 kg (45%) was fat-free mass (FFM) and 0.67 kg (55%) was fat mass (FM). At recovery, children treated for SAM had 1.27 kg lower weight, 0.38 kg lower FFM, and 0.90 kg lower FM compared to community controls. However, their fat-free mass index (FFMI) was not different from community controls (Δ0.2 kg/m2; 95% CI −0.1, 0.4). No differences were observed in FFM, FM or fat mass index (FMI) between the study arms at recovery. However, FFMI was 0.35 kg/m2 higher at recovery with the reduced compared to standard dose (p = 0.007) due to slightly lower height (Δ0.22 cm; p = 0.25) and higher FFM (Δ0.11 kg; p = 0.078) in the reduced dose group. Conclusions Almost half of the weight gain during SAM treatment was FFM. Compared to community controls, children recovered from SAM had a lower FM while their height-adjusted FFM was similar. There was no evidence of a differential effect of a reduced RUTF dose on the tissue accretion of treated children when compared to standard treatment.
  • References (38)
  • Citations (0)
📖 Papers frequently viewed together
1 Citations
1996
78% of Scinapse members use related papers. After signing in, all features are FREE.
References38
Newest
#2Peter Davies (UQ: University of Queensland)H-Index: 92
Last. Tim J. ColeH-Index: 120
view all 4 authors...
Background: Until recently, pediatric body composition reference data were very limited, hindering interpretation of measurements. In the last decade, such data emerged for several techniques for children ≥ 5 years, but equivalent data for younger age groups remain lacking, due to their poor compliance with most techniques. Objectives: To provide reference data for use in clinical practice and research from 6 weeks to 5 years, that are based on measurements of total body water (TBW) by isotope d...
Source
#1Suvi T. Kangas (Action Against Hunger)H-Index: 1
#2Cécile Salpéteur (Action Against Hunger)H-Index: 6
Last. Pernille Kæstel (UCPH: University of Copenhagen)H-Index: 17
view all 8 authors...
Background Children with uncomplicated severe acute malnutrition (SAM) are treated at home with ready-to-use therapeutic foods (RUTFs). The current RUTF dose is prescribed according to the weight of the child to fulfil 100% of their nutritional needs until discharge. However, there is doubt concerning the dose, as it seems to be shared, resulting in suboptimal cost-efficiency of SAM treatment. We investigated the efficacy of a reduced RUTF dose in community-based treatment of uncomplicated SAM. ...
1 CitationsSource
#1Victor O. Owino (IAEA: International Atomic Energy Agency)H-Index: 13
#2Alexia A.J. Murphy-Alford (IAEA: International Atomic Energy Agency)
Last. Alan Jackson (Southampton General Hospital)H-Index: 86
view all 7 authors...
Severe and moderate acute malnutrition are among the leading causes of mortality among children in low‐ and middle‐income countries. There is strong evidence that growth assessed anthropometrically from conception to 2 years of age marks later risk of ill health. This is central to the concept of the developmental origins of adult disease and is presumed to be related to modification of developmental processes during critical “window(s)” of vulnerability. Interventions to treat acute malnutritio...
Source
#1Christine M. McDonald (Children's Hospital Oakland Research Institute)H-Index: 1
#2Robert S Ackatia-Armah (UC Davis: University of California, Davis)H-Index: 2
Last. Kenneth H. Brown (BMGF: Bill & Melinda Gates Foundation)H-Index: 67
view all 6 authors...
Source
#1James M. Njunge (Wellcome Trust)H-Index: 4
#2Agnes Gwela (Wellcome Trust)H-Index: 2
Last. James A. Berkley (University of Oxford)H-Index: 41
view all 12 authors...
High mortality after discharge from hospital following acute illness has been observed among children with Severe Acute Malnutrition (SAM). However, mechanisms that may be amenable to intervention to reduce risk are unknown. We performed a nested case-control study among HIV-uninfected children aged 2–59 months treated for complicated SAM according to WHO recommendations at four Kenyan hospitals. Blood was drawn from 1778 children when clinically judged stable before discharge from hospital. Cas...
1 CitationsSource
#1Christian Fabiansen (UCPH: University of Copenhagen)H-Index: 6
#2Charles W. Yaméogo (UCPH: University of Copenhagen)H-Index: 5
Last. Henrik Friis (UCPH: University of Copenhagen)H-Index: 43
view all 15 authors...
Background Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplement (LNS) or corn-soy blend (CSB). We assessed the effectiveness of (a) matrix, i.e., LNS or CSB, (b) soy quality, i.e., soy isolate (SI) or dehulled soy (DS), and (c) percentage of total protein from dry skimmed milk, i.e., 0%, 20%, or 50%, in increasing fat-free tissue accretion. Methods and findings Between September 9, 2013, and August 29, 2014, a randomised 2 × 2 × 3 factorial trial recru...
14 CitationsSource
#1Natasha Lelijveld (UCL: University College London)H-Index: 4
#2Andrew Seal (UCL: University College London)H-Index: 19
Last. Marko Kerac (UCL: University College London)H-Index: 18
view all 11 authors...
Summary Background Tackling severe acute malnutrition (SAM) is a global health priority. Heightened risk of non-communicable diseases (NCD) in children exposed to SAM at around 2 years of age is plausible in view of previously described consequences of other early nutritional insults. By applying developmental origins of health and disease (DOHaD) theory to this group, we aimed to explore the long-term effects of SAM. Methods We followed up 352 Malawian children (median age 9·3 years) who were s...
55 CitationsSource
#1Tsinuel Girma (JU: Jimma University)H-Index: 12
#2Pernille Kæstel (UCPH: University of Copenhagen)H-Index: 17
Last. Jonathan C. K. Wells (ICH: UCL Institute of Child Health)H-Index: 62
view all 9 authors...
Summary Background & objectives Restoration of body composition indicates successful management of severe acute malnutrition (SAM). Bioimpedance (BI) index (height 2 /resistance) is used to predict total body water (TBW) but its performance in SAM, especially with oedema, requires further investigation. Subjects/Methods Children with SAM (mid-arm circumference 2 /Z. Xc and R were height (H)-indexed, and Xc/H plotted against R/H. Results Thirty five children (16 non-oedematous and 19 oedematous) ...
7 CitationsSource
#1Paluku BahwereH-Index: 18
#2Bisimwa Balaluka (CUA: The Catholic University of America)H-Index: 1
Last. Steve CollinsH-Index: 20
view all 8 authors...
BACKGROUND: The cost of current standard 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 standard peanut paste-based RUTF (P-RUTF). DESIGN: We used a nonblinded, parallel-group, simple randomized controlled ...
21 CitationsSource
#1Elazar Tadesse (Uppsala University)H-Index: 4
#2Yemane Berhane (Addis Continental Institute of Public Health)H-Index: 36
Last. Eva-Charlotte Ekström (Uppsala University)H-Index: 23
view all 5 authors...
Background: Severe acute child malnutrition (SAM) is associated with high risk of mortality. To increase programme effectiveness in management of SAM, community-based management of acute malnutrition (CMAM) programme that treats SAM using ready-to-use-therapeutic foods (RUTF) has been scaled-up and integrated into existing government health systems. The study aimed to examine caregivers’ and health workers perceptions of usages of RUTF in a chronically food insecure area in South Ethiopia. Metho...
10 CitationsSource
Cited By0
Newest