Effectiveness of a Locally Produced, Fish-Based Food Product on Weight Gain among Cambodian Children in the Treatment of Acute Malnutrition: A Randomized Controlled Trial

Sigh, Sanne; Roos, Nanna; Chamnan, Chhoun; Laillou, Arnaud; Prak, Sophanneary; Wieringa, Frank T.

doi:10.3390/nu10070909

Cited by 39 publications

(76 citation statements)

References 49 publications

(66 reference statements)

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“…Linear growth observed in the trial (2.6 mm/week with reduced dose and 2.8 mm/week with standard dose) is in line with other CMAM studies [5,6,9,10,16,19,38] and with the 2.8 mm/week growth rates expected in healthy 13-month-old children [39]. However, the reduced dose slowed down the linear growth of children by 0.2 mm/week (95% CI 0.04 to 0.4; p = 0.015).…”

Section: Discussionsupporting

confidence: 90%

Impact of reduced dose of ready-to-use therapeutic foods in children with uncomplicated severe acute malnutrition: A randomised non-inferiority trial in Burkina Faso

et al. 2019

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Background Children with uncomplicated severe acute malnutrition (SAM) are treated at home with ready-to-use therapeutic foods (RUTFs). The current RUTF dose is prescribed according to the weight of the child to fulfil 100% of their nutritional needs until discharge. However, there is doubt concerning the dose, as it seems to be shared, resulting in suboptimal cost-efficiency of SAM treatment. We investigated the efficacy of a reduced RUTF dose in community-based treatment of uncomplicated SAM. Methods and findings We undertook a randomised trial testing the non-inferiority of weight gain velocity of children with SAM receiving (a) a standard RUTF dose for two weeks, followed by a reduced dose thereafter (reduced), compared with (b) a standard RUTF dose throughout the treatment (standard). A mean difference of 0.0 g/kg/day was expected, with a non-inferiority margin fixed at −0.5 g/kg/day. Linear and logistic mixed regression analyses were performed, with study site and team as random effects. Between October 2016 and July 2018, 801 children with uncomplicated SAM aged 6–59 months were enrolled from 10 community health centres in Burkina Faso. At admission, the mean age (± standard deviation [SD]) was 13.4 months (±8.7), 49% were male, and the mean weight was 6.2 kg (±1.3). The mean weight gain velocity from admission to discharge was 3.4 g/kg/day and did not differ between study arms (Δ 0.0 g/kg/day; 95% CI −0.4 to 0.4; p = 0.92) confirming non-inferiority ( p = 0.013). However, after two weeks, the weight gain velocity was significantly lower in the reduced dose with a mean of 2.3 g/kg/day compared with 2.7 g/kg/day in the standard dose (Δ −0.4 g/kg/day; 95% CI −0.8 to −0.02; p = 0.041). The length of stay (LoS) was not different ( p = 0.73) between groups with a median of 56 days (interquartile range [IQR] 35–91) in both arms. No differences were found between reduced and standard arm in recovery (52.7% and 55.4%; p = 0.45), referral (19.2% and 20.1%; p = 0.80), defaulter (12.2% and 8.5%; p = 0.088), non-response (12.7% and 12.5%; p = 0.95), and relapse (2.4% and 1.8%; p = 0.69) rates, respectively. However, the reduced RUTF dose had a small 0.2 mm/week (95% CI 0.04 to 0.4; p = 0.015) negative effect on height gain velocity with a mean height gain of 2.6 mm/week with reduced and 2.8 mm/week with standard RUTF dose. The impact was more pronounced in children under 12 months of age (interaction, p = 0.019) who gained 2.8 mm/week with reduced and 3.1 mm/week with standard dose (Δ −0.4 mm/week; 95% CI −0.6 to −0.2; p < 0.001). Limitations include not blinding participants to the RUTF dose received and excluding all children with negative appetite t...

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Section: Discussionsupporting

confidence: 90%

Impact of reduced dose of ready-to-use therapeutic foods in children with uncomplicated severe acute malnutrition: A randomised non-inferiority trial in Burkina Faso

et al. 2019

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“…This suggests that the locally-produced fish-based RUTF performed as well as BP-100™ and is a potential alternative to the latter for SAM treatment in Cambodia. Details on the RUTF effectiveness trial are reported elsewhere [46].…”

Section: Methodsmentioning

confidence: 99%

Development and testing of locally-produced ready-to-use therapeutic and supplementary foods (RUTFs and RUSFs) in Cambodia: lessons learned

Borg

Mihrshahi

Laillou³

et al. 2019

BMC Public Health

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Background Rates of childhood undernutrition are persistently high in Cambodia. Existing ready-to-use supplementary and therapeutic foods (RUSFs and RUTFs) have had limited acceptance and effectiveness. Therefore, our project developed and trialled a locally-produced, multiple micronutrient fortified lipid-based nutrient supplement (LNS) with therapeutic and supplementary versions. This ready-to-use food (RUF) is innovative in that, unlike many RUFs, it contains fish instead of milk. Development began in 2013 and the RUF was finalised in 2015. From 2015 until the present, both the RUTF and the RUSF versions were trialled for acceptability and effectiveness. Methods This paper draws on project implementation records and semi-structured interviews to describe the partnership between the Cambodian Ministries of Health and Agriculture, Forestry and Fisheries, UNICEF, the French National Research Institute for Sustainable Development (IRD), universities, and Vissot factory. It discusses the project implementation and lessons learned from the development and trialling process, and insights into positioning nutrition on the health agenda in low and middle-income countries. Results The lessons learned relate to the importance of project planning, management, and documentation in order to seize opportunities in the research, policy, advocacy, and programming environment while ensuring adequate day-to-day project administration and resourcing. Conclusions We conclude that projects such as ours, that collaborate to develop and test novel, locally-produced RUTFs and RUSFs, offer an exciting opportunity to respond to both local programmatic and broader research needs.

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“…Replacement of lost fish with other food sources is beyond the scope of this analysis, but is an important future direction for research. Some groups have even demonstrated, through randomized control trials, the importance of local fish food products in improving Cambodian nutrition (Sigh et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Impacts of Mainstream Hydropower Development on Fisheries and Human Nutrition in the Lower Mekong

Golden

Shapero

Vaitla

et al. 2019

Front. Sustain. Food Syst.

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Dams provide energy and irrigation water, but also alter natural water flows that support fisheries. This tradeoff presents a risk for human nutrition in regions dependent on aquatic foods, including the Lower Mekong Basin (LMB), where over 100 dams are planned or in construction. Previous models estimate significant reductions in fishery production resulting from these dams. This study estimates the number of new nutritionally insecure people (i.e., those at risk for nutritional deficiencies) associated with Mekong damming. We calculated population-level nutritional needs based on the Estimated Average Requirements (EARs) for Cambodia and the entire LMB. We then estimated fish-derived nutrient supplies by integrating data on annual fishery production and fish nutrient content for a wide range of species. Finally, we synthesized available literature and modeling results on the impacts of damming on fisheries production, and estimated the consequent impact on inadequate intakes of protein, zinc, niacin, thiamin, riboflavin, and calcium, as well as potential vulnerability to losses of dietary iron. Hydropower development could restrict access to subsistence fish from the Mekong River Basin and lead to increased risk of nutritional deficiencies in Cambodia and the LMB. Our median estimates suggest that by 2030, relative to 2010, inadequate intakes could lead to an increased population at risk of nutritional deficiencies in the LMB by 0.21 to 2.23 million people for protein, 0.12 to 1.17 million people for zinc, 0.41 to 1.58 million people for niacin, 0.47 to 0.87 million people for thiamin, 0.70 to 2.31 million people for riboflavin, and approximately 10,000 people for calcium. This increased population at risk is additional to those currently malnourished. We then calculated that the average iron intake of many age-sex groups (constituting 58% of the population) will be below 150% of their EAR in 2030, indicating a potential risk of increased inadequate iron intake. Fish is the main source of animal source foods and critical micronutrients in the LMB. In the absence of mitigation efforts, any reductions in fishery production could increase already high levels of nutrient deficiency, creating a widespread risk of nutrition insecurity.

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Effectiveness of a Locally Produced, Fish-Based Food Product on Weight Gain among Cambodian Children in the Treatment of Acute Malnutrition: A Randomized Controlled Trial

Cited by 39 publications

References 49 publications

Impact of reduced dose of ready-to-use therapeutic foods in children with uncomplicated severe acute malnutrition: A randomised non-inferiority trial in Burkina Faso

Impact of reduced dose of ready-to-use therapeutic foods in children with uncomplicated severe acute malnutrition: A randomised non-inferiority trial in Burkina Faso

Development and testing of locally-produced ready-to-use therapeutic and supplementary foods (RUTFs and RUSFs) in Cambodia: lessons learned

Impacts of Mainstream Hydropower Development on Fisheries and Human Nutrition in the Lower Mekong

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