Treating high-risk moderate acute malnutrition using therapeutic food compared with nutrition counseling (Hi-MAM Study): a cluster-randomized controlled trial. Issue 3 (8th May 2021)

• Record Type: Journal Article
• Authors: Lelijveld, Natasha; Godbout, Claire; Krietemeyer, Destiny; Los, Alyssa; Wegner, Donna; Hendrixson, David T; Bandsma, Robert; Koroma, Aminata; Manary, Mark
• Is Part Of: American journal of clinical nutrition. Volume 114:Issue 3(2021)
• Page Start: 955
• Page End: 964
• Publication Date: 2021-05-08
• Subjects: moderate acute malnutrition -- wasting -- supplementary feeding -- RUTF -- nutrition counseling -- Sierra Leone; Diet therapy -- Periodicals; Nutrition -- Periodicals; Dietetics -- Periodicals; 613.205
• DOI: 10.1093/ajcn/nqab137
• Languages: English
• ISSNs: 0002-9165

Abstract

ABSTRACT: Background: There is a lack of consensus on what is the most appropriate treatment of moderate acute malnutrition (MAM). Objectives: We aimed to determine if provision of ready-to-use-therapeutic food (RUTF) and antibiotics to "high-risk" MAM (HR-MAM) children in addition to nutritional counseling would result in higher recovery and less deterioration than nutrition counseling alone. Methods: At the 11 intervention clinics, HR-MAM children were given RUTF and amoxicillin along with standard nutrition counseling, for 2–12 wk. All others received 6 wk of nutrition counseling alone. HR-MAM was defined as midupper arm circumference (MUAC) <11.9 cm, weight-for-age z score (WAZ) <−3.5, mother not the main caregiver, or a child <2 y old not being breastfed. Outcomes were compared using intention-to-treat analysis. Results: Analysis included 573 children at the intervention sites and 714 children at the control sites. Of the intervention group, 317 (55%) were classified as HR-MAM. Short-term recovery was greater at the intervention sites [48% compared with 39% at week 12; risk difference (rd): 0.08; 95% CI: 0.03, 0.13]. The intervention group had lower risk of deteriorating to severe acute malnutrition (SAM) (18% compared with 24%; rd: −0.07; 95% CI: −0.11, −0.04), lower risk of dying (1.8% compared with 3.1%; rd: −0.02; 95% CI: −0.03, −0.00), and greater gains in MUAC and weight than did children at the control sites. However, by 24 wk, the risk of SAM was similar between the 2 arms (31% compared with 34%; rd: −0.03; 95% CI: −0.09, 0.02). Control group data identified recent illness, MUAC <12.0 cm, WAZ <−3, dropping anthropometry, age <12 mo, being a twin, and a history of previous SAM as risk factors for deterioration. Conclusions: Provision of RUTF and antibiotics to HR-MAM children improved short-term recovery and reduced short-term risk of deterioration. However, recovery rates were still suboptimal and differences were not sustained by 6 mo post enrollment. This trial was registered at clinicaltrials.gov as NCT03647150.