An Optimized Dose of Therapeutic Feeding Results in Noninferior Growth in Midupper Arm Circumference Compared with a Standard Dose in Children in Sierra Leone Recovering from Acute Malnutrition. Issue 2 (2nd February 2021)

• Record Type: Journal Article
• Authors: Stephenson, Kevin B; Agapova, Sophia E; Hendrixson, D Taylor; Koroma, Aminata Shamit; Manary, Mark J
• Is Part Of: Current developments in nutrition. Volume 5:Issue 2(2021)
• Publication Date: 2021-02-02
• Subjects: community-based management of acute malnutrition -- moderate acute malnutrition -- severe acute malnutrition -- ready-to-use therapeutic food -- supplementary feeding -- midupper arm circumference -- wasting -- stunting -- child; Nutrition -- Periodicals; Nutritional Physiological Phenomena; Nutrition; Periodicals; Periodicals; Fulltext; Internet Resources; Periodicals; 612.3
• DOI: 10.1093/cdn/nzab007
• Languages: English
• ISSNs: 2475-2991

Abstract

ABSTRACT: Background: Ready-to-use therapeutic food (RUTF) given at 175 kcal/kg per day throughout severe acute malnutrition (SAM) treatment is recommended. Some treatment programs have diverged from this paradigm in 2 ways: reducing the supplemental food dose to 75 kcal/kg per day when midupper arm circumference (MUAC) is >11.4 cm or simplifying to a fixed-dose regimen. Objective: The objective was to determine if transitioning to an optimized, fixed-dose supplementary feeding regimen during SAM treatment when MUAC is >11.4 cm would result in noninferior gain in MUAC compared with standard treatment. Methods: Using data from 2 clinical trials conducted in Sierra Leone, a retrospective dual-cohort study was performed. The 2 cohorts included children with SAM who had improved to meet criteria for moderate acute malnutrition (MAM). The standard dose cohort continued to receive weight-based RUTF at 175 kcal/kg per day, while the optimized dose cohort received fixed-dose, 500 kcal/d of supplementary feeding. The primary outcome was a noninferiority margin of 1 mm of MUAC after 4 wk of treatment, while secondary outcomes included rate of anthropometric changes as well as time-to-relapse to SAM or death. Results: MUAC after 4 wk was noninferior (Δ: −0.1 mm; 95% CI: −0.05, 0.03; inferiority rejected P = 0.008). Rates of weight gain and MUAC gain were the same in the optimized-dose and standard-dose groups, whereas the rate of length gain was slower in the optimized-dose cohort. Time-to-relapse to SAM or death was not different (HR: 1.05; P = 0.71). Conclusions: This study supports the practice of treating children with SAM who have recovered to meet criteria for MAM with a reduced and fixed-dose regimen of RUTF. The results also raise the question of whether this strategy might adversely impact linear growth during SAM treatment. Abstract : We found that reducing the dose of therapeutic food for children with severe acute malnutrition during recovery results in a similar resolution of wasting, but may result in a reduced linear growth.