There is growing evidence that childhood malnutrition is associated with non-communicable diseases (NCDs) in adulthood and that body composition mediates some of this association. This review aims to determine: if childhood body composition can be used to predict later-life cardiometabolic NCDs and which measures of body composition best predict future NCDs. Three electronic databases were searched for studies where: children aged under 5 years had body composition measured; cardiometabolic health outcomes were measured a minimum of 10 years later. 29 studies met the inclusion criteria. Though a poor proxy measure of body composition, Body mass index (BMI) was commonly reported (n=28, 97%). 25% of these studies included an additional measure (Ponderal Index or skinfold thickness). Only some studies adjusted for current body size (n=11, 39%). Many studies reported that low infant BMI and high childhood BMI were associated with increased the risk of NCD-related outcomes in later life but no conclusions can be made about exact timing of child malnutrition and consequent impact on NCD. Because studies focused on BMI rather than direct measures of body composition, nothing can be said about which measures of body composition in childhood are most useful. Future research on child nutrition and long-term outcomes is urgently needed and should include validated body composition assessments as well as standard anthropometric and BMI measurements.

Background Malnutrition is a leading cause of morbidity and mortality in children aged <5 y, especially in low- and middle-income countries (LMICs). Unlike severe acute malnutrition, moderate acute malnutrition (MAM) affects greater numbers globally, and guidelines lack a robust evidence base. This systematic review and meta-analysis assessed the evidence for lipid-based nutrient supplements (LNSs), fortified blended flours (FBFs) and nutrition counselling, in the treatment of MAM. Methods Four databases were systematically searched for studies conducted in LMICs that compared the effectiveness of food-based products with any comparator group in promoting recovery from MAM in children aged 6-59 mo. Where appropriate, pooled estimates of effect were estimated using random-effects meta-analyses. Results A total of 13 trials were identified for inclusion. All used active controls. There was evidence of increased probability of recovery (gaining normal weight-for-height and/or mid-upper arm circumference) among children treated with LNSs compared with children treated with FBFs (risk ratio 1.05, 95% CI 1.01 to 1.09, p=0·009). Conclusion Based on a relatively small number of studies mainly from Africa, LNSs are superior to FBFs in improving anthropometric recovery from MAM. Current evidence for the use of food supplements in MAM treatment is based on comparisons with active controls. Future studies should assess a wider range of comparator groups, such as nutrition education/counselling alone, and outcomes, including body composition, morbidity and development.

BackgroundMalnutrition is a leading cause of morbidity and mortality in children aged under five years, especially in low- and middle-income countries (LMICs). Although severe acute malnutrition (SAM) is considered the most serious form of malnutrition, moderate acute malnutrition (MAM) affects greater numbers globally and, unlike SAM, guidelines lack a robust evidence-base. This systematic review and meta-analysis assessed the evidence for lipid-based nutrient supplements (LNS), fortified-blended-flours (FBF) and nutrition counselling, in the treatment of MAM.MethodsFive databases were systematically searched for studies conducted in LMICs that compared the effectiveness of food-based products versus any comparator group in promoting recovery from MAM in children aged 6-59 months. Where appropriate, pooled estimates of effect were estimated using random-effects meta-analyses.ResultsA total of thirteen trials were identified for inclusion. All used active controls rather than ‘standard care’, which is often minimal in most settings. There was evidence of increased probability of recovery (as assessed by gaining normal weight-for-height and/or MUAC) among children treated with LNS compared to children treated with FBF (RR 1·05, 95%CI 1·01-1·09, p=0·009). Treatment with an LNS was also associated with a lower risk of persistent MAM at the end of treatment compared with a FBF (RR 0·82, 95%CI 0·71-0·95, p=0·007).ConclusionBased on a relatively small number of studies mainly from Africa, LNS are superior to FBF in improving anthropometric recovery from MAM. The true benefit of MAM treatment may be underestimated due to all studies using active controls rather than usual care which is minimal.More high-quality evidence is needed to evaluate nutrition education/counselling alone as a MAM intervention. Studies should also assess a wider range of outcomes including body composition, morbidity and development – not weight-gain alone.