Nutritional quality of a ready-to-use food, and its acceptability to healthy and HIV-infected children receiving antiretroviral treatment

Objectives: The objectives of this study were to determine the nutritional quality of a ready-to-use food (RUF), and its acceptability to children who were “healthy” and to those who were human-immunodeficiency virus (HIV)-infected and receiving antiretroviral therapy (ART).Design: This was a cross-sectional survey that assessed the consumer acceptability of the RUF by the children.Setting and subjects: One hundred and eighty-eight children were selected from six schools, a day care and a hospital in Pietermaritzburg. Of these children, 123 were “healthy”, and 65 HIV-infected and receiving ART.Outcome measures: The outcome measure of the study was the nutritional quality of the RUF in terms of its nutrient levels relative to appropriate nutritional standards, and its acceptability rating by the children.Results: The RUF had appreciable levels of energy (2 624 kJ/100 g) and protein (15.7 g/100 g).The nutritional composition met the World Health Organization/World Food Programme/the United Nations Standing Committee on Nutrition/The United Nations Children’s Fund recommendations for an RUF regarding energy, protein and essential amino acid levels. Sensory evaluation indicated that the RUF was acceptable to both children who were healthy and to those who were  HIV-infected. Generally, more than 75% of the participants in both groups rated the product overall as “good”. More than 65% of the children liked the taste, smell and mouth feel.Conclusion: The RUF that was used in this study is a good source of energy and quality protein, and is acceptable to children. Further micronutrient analysis would determine the additional role of the RUF in alleviating micronutrient deficiencies, including vitamin A, zinc and iron. Since the RUF is acceptable to children who were healthy and to those who were  HIV-infected on ART, it can be used to address proteinenergy malnutrition in these target groups

Optimal iron content in ready-to-use therapeutic foods for the treatment of severe acute malnutrition in the community settings: A protocol for the systematic review and meta-analysis

Introduction: The current standard of care for children with severe acute malnutrition (SAM) involves using ready-to-use therapeutic food (RUTF) to promote growth; however, the precise formulation to achieve optimal recovery remains unclear. Emerging research suggests that alternative RUTF formulations may be more effective in correcting SAM-related complications such as anaemia and iron deficiency. This systematic review commissioned by the WHO aims to synthesise the most recent research on the iron content in RUTF and related products in the community-based treatment of uncomplicated severe malnutrition in children aged 6 months and older. Methods and analysis: We will search multiple electronic databases. We will include randomised controlled trials and non-randomised studies with a control arm. The intervention group will be infants who received RUTF treatments other than the current recommended guidelines set forth by the WHO. The comparison group is children receiving RUTF containing iron at the current WHO-recommended level of 1.9 mg/100 kcal (10-14 mg/100 g). The primary outcomes of interest include blood haemoglobin concentration, any anaemia, severe anaemia, iron-deficiency anaemia, recovery from SAM and any adverse outcomes. We will use meta-analysis to pool findings if sufficient homogeneity exists among included studies. The risk of bias in studies will be evaluated using the Cochrane risk of bias-2. We will use the Grading of Recommendations Assessment, Development, and Evaluation(GRADE) approach to examine the overall certainty of evidence. Ethics and dissemination: This is a systematic review and will not involve direct contact with human subjects. The findings of this review will be published in a peer-reviewed journal and will guide the WHO\u27s recommendation on the optimal iron content in RUTFs for the treatment of SAM in children aged 6-59 month

Prognostic Accuracy of WHO Growth Standards to Predict Mortality in a Large-Scale Nutritional Program in Niger

Rebecca Grais and colleagues assess the accuracy of WHO growth standards in predicting death among malnourished children admitted to a large nutritional program in Niger

Simplified, combined protocol for acute malnutrition in children 6-59 months : the ComPAS randomized controlled trial

Background: Children 6-59 months with uncomplicated severe and moderate acute malnutrition (SAM and MAM) are treated in separate programs with different food products. The aim of this research was to generate evidence on a simplified, combined SAM and MAM approach, using a mid-upper arm circumference (MUAC)-based dosage protocol. Methods: An analysis of routine program data of 5,518 children from five countries estimated the energy requirements of children recovering from acute malnutrition to develop a MUAC-based combined protocol. A cluster-randomized controlled trial in Kenya and South Sudan tested if the combined protocol was as effective at recovering children but more cost-effective than standard treatment. A secondary analysis explored outcomes in children with low weight-for-age (WAZ <-3.0) and/or MUAC <11.5 cm. Results: In the routine program analysis, energy requirements for children with a MUAC <12.5 cm could be met or exceeded by 1,000 kcal/day. In the trial, 2,488 children completed treatment; 981 (76.3%) on the combined protocol and 884 (73.5%) on the standard protocol recovered. The combined protocol was non-inferior to standard treatment at a 10% non-inferiority margin, with a risk difference of 0.03 (95% CI -0.05 to 0.10, p=0.52) in per-protocol analysis, adjusted for country, age and sex. The amount of ready-to-use food to fully recover a child admitted with SAM was less in the combined protocol (122 versus 193 sachets), and the combined protocol cost $123 less per child recovered ($918 vs 1,041). Children with a WAZ <-3.0 or a MUAC <11.5 cm respond similarly to the combined protocol or standard treatment. Conclusion: A simplified, combined protocol for SAM and MAM achieves similar recovery as standard treatment and improves cost-effectiveness. Improving cost-effectiveness may enable health programs to treat more children. Adding WAZ <-3 as an admission criterion to simplified programs may help target high-risk children who benefit from treatment

Design and pre-testing of lipid-based, ready-to-use foods for the prevention and treatment of malnutrition in low-resource settings

Background: Managing child and adult undernutrition is a global public health priority. In poor settings, improved specialised products are needed for treatment and prevention, including for chronic disease/HIV. Objective: To develop a method for the design and pre‐clinical testing of novel, low‐cost Ready‐to‐Use Therapeutic Foods (RUTF), to be also applied to supplementary/complementary feeding interventions. A method was developed and tested, using four sequential studies, with HIV‐positive Kenyan adults with severe acute malnutrition (case‐study). A qualitative study explored adherence and consumption barriers with the current UNstandard peanut/milk‐powder‐based therapeutic formulation (P‐RUTF). A study using Linear Programming (LP) designed an improved, cheaper formulation soy/maize/sorghum‐based (SMS‐RUTF), considered accurate if: its manufactured prototype, compared to calculated values; it had a measured energy density difference (EDD) <10%; a protein or lipid difference (P/LD) <5g/100g. An acceptability study (4‐weeks‐cross‐over design; washout one‐week) compared use of SMS‐RUTF against P‐RUTF (n=41), using 18 consumption/safety/preference criteria. Based on a literature review (28 randomized controlled trials of micronutrient supplementation; outcomes: increased survival and CD4 cell count, reduced viral load), four criteria to determine micronutrient specifications for the SMS‐RUTF fortification were developed and applied. The reported compliance with the prescribed RUTF was relatively low, and informed the necessary formulation improvements. The LP-determined formulation was accurate (EDD: 7%; PD and LD: 2.3 and 1.0g/100g). The LP-based prototype was acceptable and safe, but with an average number of days of nausea and vomit (0.16 and 0.04 d) occurred with a higher frequency (P < 0.05) than in the control (0.09 and 0.02 d). The existing evidence for determining micronutrient specifications for SMS�]RUTF posed some challenges for the development of manufacturing specifications. Twelve of the micronutrient specifications developed for SMS�]RUTF fortificant premix were equivalent to the UN minimum standards; eleven were 2 to 10 times higher. Conclusions: The proposed set of methods can be used to design and pre�]clinically test improved/cheaper RUTF products, targeting malnourished adults. Novel formulations should be clinically trialled before widespread�]use

Responsive feeding and child interest in food vary when rural Malawian children are fed lipid-based nutrient supplements or local complementary food

10.1111/j.1740-8709.2011.00377.xMaternal and Child Nutrition93369-38