Effectiveness of Dietary Management for Moderate Wasting among Children > 6 Months of Age—A Systematic Review and Meta-Analysis Exploring Different Types, Quantities, and Durations

Abstract

Currently, no World Health Organization guidelines exist for the management of approximately 31.8 million moderately wasted children globally. The objective of this review was to synthesise evidence on the optimal type, quantity, and duration of dietary treatment for moderate wasting. Ten electronic databases were searched until the 23rd of August 2021. Experimental studies comparing interventions for the dietary management of moderate wasting were included. Meta-analyses were conducted and results were presented as risk ratios or mean differences with 95% confidence intervals. Seventeen studies comparing specially formulated foods were included involving 23,005 participants. Findings suggest little or no difference in recovery between Fortified Blended Foods (FBFs) with improved micronutrient and/or milk content (enhanced FBFs) and lipid-based nutrient supplements (LNS), whereas children treated with non-enhanced FBFs (locally produced FBFs or standard corn–soy blend) may have lower recovery rates than those treated with LNS. There was no difference in recovery when ready-to-use therapeutic and ready-to-use supplementary food were compared. Other outcomes mostly aligned with results for recovery. In conclusion, LNSs improve recovery compared to non-enhanced FBFs, but are comparable to enhanced FBFs. Programmatic choice of supplement should consider factors such as cost, cost-effectiveness, and acceptability. Further research is required to determine optimal dosing and duration of supplementation.

Impact of a simplified treatment protocol for moderate acute malnutrition with a decentralized treatment approach in emergency settings of Niger

“…Despite a recent meta-analysis on MAM treatment ( 49 ) concluding that RUTF and RUSF showed little or no difference in recovery rate (risk ratio: 1.02 [0.98–1.05]), the influence on recovery could be indirect since RUTF may lead to an increase in daily weight gain when compared to RUSF (mean difference of 0.2 g/kg/day; 95% CI: 0.08 to 0.32). If we look at anthropometric gain presented in this study, the group with the simplified protocol far exceeded the CMAM protocol group in both anthropometric indicators (weight: 4.46 vs. 3.08 g/Kg/day; MUAC: 0.34 vs. 0.19 mm/day).…”

Infant and Young Child Feeding (IYCF) Practices in Rural and Urban Regions of Indonesia

“…Household socioeconomic status (wealth index, food security status, and household income) and child age were found to be among the actors statistically significantly associated with complementary feeding practices indicators [28]. Complementary feeding education for caregivers can also be used to improve nutrition outcomes among infants in both food-secure and -insecure populations [29]. The factors related to the earlier introduction of complementary feeding were lower education level (in Poland and Austria primary and vocational respectively), preterm birth, never breastfeeding, and receiving an infant formula after hospital discharge at maternal age [30].…”

A microbiota-directed complementary food intervention in 12-18-month-old Bangladeshi children improves linear growth

“…Wasting and stunting are typically treated differently. Wasting is treated with high energy micronutrient-fortified ready-to-use supplementary or therapeutic foods (RUSF/RUTF) in the community or in hospital-based settings 9,10 . Approaches to treating stunting have been multifaceted, including strategies to reduce enteropathogen burden and environmental enteric dysfunction (EED) 11 through access to clean water, sanitation, and improved hygiene (WASH), as well as various maternal, infant and young child feeding programs.…”