Ready-to-Use Therapeutic Food for Catch-Up Growth in Children after an Episode of Plasmodium falciparum Malaria: An Open Randomised Controlled Trial

Background: Catch-up growth after an infection is essential for children to maintain good nutritional status. To prevent malnutrition, WHO recommends that children are given one additional healthy meal per day during the 2 weeks after onset of illness. We investigated to what extent ready-to-use therapeutic food (RUTF) promotes catch-up growth in children after an acute, uncomplicated episode of Plasmodium falciparum malaria. Methods: We did an open randomised trial of children aged 6–59 months with confirmed malaria who attended a Médecins Sans Frontières-supported outpatient clinic in Katanga Province, Democratic Republic of Congo. All children received a clinical examination and malaria treatment. Patients were then randomly assigned to either an RUTF group, who received daily supplemental RUTF (a high-protein peanut-based paste) for 14 days, or to a control group, who received no supplemental food. Children were weighed at baseline and on days 14 and 28. The primary outcome was mean weight change after 14 days ’ RUTF. Analysis was by intention-to-treat. Results: 93 children received RUTF and 87 received no food supplementation. At day 14, the RUTF group had a mean weight gain of 353 g compared with 189 g in the control group (difference 164 [95%CI 52–277], p = 0.005). However, at day 28 there was no statistically significant difference between the groups (539 g versus 414 g, respectively [p = 0.053]). Similarly, rate of weight gain per kg bodyweight per day was significantly higher at day 14 in the RUTF group (2.4 g/kg pe

Baseline characteristics.

<p>RUTF: ready-to-use therapeutic food. MUAC: middle-upper arm circumference.</p>a<p>Number (%).</p>b<p>mean ± SD: standard deviation.</p>c<p>mean (median, IQR: interquartile range).</p>d<p>91 patients analysed in the intervention group and 83 in the control group.</p><p>symptom in the 14 days prior to study inclusion.</p>f<p>axillary temperature &gt;38°C.</p>g<p>3 or more liquid stools in any 24 hour period.</p>h<p>occasional persistent vomiting.</p

Mean rate of weight change (g/kg per day), stratified by sex.

a<p>Mean (95% CI) n.</p>b<p>Mean (95% CI).</p>¥<p>likelihood ratio test (LRT) for effect modification.</p

Number gaining any weight (&gt;0 g).

a<p>n (%).</p>b<p>OR (95% CI).</p>c<p>RUTF n = 88, control n = 86.</p>d<p>RUTF n = 87, control n = 84.</p

Trial profile.

<p>Trial profile.</p

Mean rate of weight change (g/kg per day), stratified by breastfeeding.

a<p>Mean (95% CI) n.</p>b<p>Mean (95% CI).</p>¥<p>likelihood ratio test (LRT) for effect modification.</p

Mean weight gain (g).

a<p>mean (95% CI) SD.</p>b<p>RUTF n = 88, control n = 86.</p>c<p>RUTF n = 87, control n = 84.</p