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Comparative Efficacy of Cereals and Pulse-Based Ready-to-Use Therapeutic Food and Standard Milk- and Peanut-Based Formulation in Treating Severe Acute Malnutrition

Posted:  Wednesday, October 05, 2016

Cereals and Pulse-Based Ready-to-Use Therapeutic Food Versus Standard Milk- and Peanut-Based Formulation for Treating Severe Acute Malnutrition

Severe acute malnutrition (SAM) accounts for more than half a million preventable child deaths annually. Ready-to-use therapeutic food (RUTF) is the main element of community-based management of acute malnutrition (CMAM) in SAM children. Peanut-based RUTF (P-RUTF) contains high milk content and is thus expensive. Therefore, to reduce the cost and utilize locally grown ingredients, a new soya, maize, and sorghum-based RUTF (SMS-RUTF) has been developed. This study published in the Amercian Journal of Clinical Nutrition aimed to compare the efficacy of SMS-RUTF with that of P-RUTF.

The study included children aged 6–23 and 24–59 months. A total of 886 children with SAM were randomly assigned to receive either P-RUTF (n=441) or SMS-RUTF (n=445). The primary outcomes evaluated were mean length of stay (LOS), recovery rate, and mean daily weight gain. The secondary outcomes included changes in haemoglobin and differences in body composition (fat mass and fat mass index) during recovery. The plasma concentrations of eight essential amino acids were also evaluated.

The LOS, weight gain, and recovery rate of children in the SMS-RUTF group were non-inferior to those of children in P-RUTF group in the intention-to-treat (ITT) and per-protocol (PP) analyses among children aged ≥24 months. However, among children aged ≤23 months, the recovery rate in the SMS-RUTF group was inferior compared to those in the P-RUTF group. Increase in haemoglobin was greater following treatment with SMS-RUTF. Replenishment of all the essential amino acids except methionine was seen following treatment with both RUTFs. No difference in fat mass or fat mass index was seen between the two RUTF groups at discharge.

The cost of CMAM programs can be reduced by SMS-RUTF treatement in SAM children aged ≥24 months. However, further research on the use of SMS-RUTF in younger children is warranted.

News Source: Bahwere P, Balaluka B, Wells J, et al. 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. Am J Clin Nutr. 2016;103(4):1145-1161.