Effectiveness of supplementary blended flour based on chickpea and cereals for the treatment of infants with moderate acute malnutrition in Iran: A randomized clinical trial

Abstract

BackgroundDespite the decreasing rate of under nutrition children in recent years overall, the negative affect in growth and development make it as a main concern in the world. Applying an available and appropriate supplementary food is a major approach in treating children with Moderate Acute Malnutrition (MAM).ObjectiveTo compare the effectiveness of a new supplementary blended flour (containing chickpea, rice, wheat and barley, named Shadameen) in combination with multivitamin/mineral supplement and nutritional counseling versus multivitamin/mineral supplement and nutritional counseling alone, in the treatment of children with MAM.MethodsThis randomized controlled trial study was conducted at Heshmatiyeh Hospital in Sabzevar city in Iran, from January 2016 to December 2016. Seventy infants, aged 9 to 24 months with MAM who were referred from urban health centers to the hospital clinic were included. They were randomly assigned to receive, for about 3 months, either multivitamin / mineral supplement and nutritional counseling alone or in combination with an extra supplementary blended food. We analyzed weight, length, weight for length Z score (WLZ), weight for age Z score (WAZ) and length for weight Z score (LAZ), along with recovery rate and adverse events among the two groups. The data were analyzed using SPSS version 16. We used statistics, Chi-square, independent t-test, and Fisher’s exact test for the analyses of primary and secondary outcomes.ResultsThe food supplementation infant’s mean weight and WLZ and WAZ were greater compared with the other group (0.81±0.29 gr and 0.55±0.33 gr, p=0.002), (0.36±0.36 and 0.02±0.52, p=0.003), (0.40±0.33 and 0.09±0.37, p=0.001). The recovery rate in the food supplemented group was significantly higher than the other group (68.4%, 31.6%, p=0.001). No adverse reactions were observed. There were no significant differences in LAZ at the end of the study between the two groups (p=0.53).ConclusionThis study showed that Shadameen in combination with multivitamin/mineral and counselling therapy can be more effective in decreasing the wasting rate of children with MAM than vitamin/mineral and counseling therapy alone.Trial registrationThe trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015040921670N1.FundingThis study was financially supported by the vice chancellor for research office, Mashhad University of Medical Sciences.

Systematic review of the treatment of moderate acute malnutrition using food products

“…The study by Nikièma et al () was conducted in a “relatively food‐secure” context. One other study states that it was conducted in a relatively food‐secure setting, taking place in an urban area of Iran (Javan, Kooshki, Afzalaghaee, Aldaghi, & Yousefi, ). They found food supplementation with counselling to be superior to multivitamins and counselling alone; although there was some spontaneous recovery (WHZ > −2; 32%) in the counselling group, this was much lower than in the food supplementation group (80%).…”

“…Of the studies that used WHZ < −2 and ≥−3 as the definition of MAM, the recovery rate was between 75% and 68% when providing a supplementary food intervention compared with counselling and/or micronutrient supplements, where recovery rate was between 58% and 32% (Javan et al, ; Nikièma et al, ).…”

“…The study by Nikièma et al () was conducted in a relatively food‐secure context, which may have added to its success in the per protocol analysis. However, the only other study to mention that it took place in a relatively food‐secure setting (urban Iran) still found food supplementation to be superior in recovering WHZ than micronutrients and counselling (Javan et al, ). It is generally felt that counselling alone is not sufficient in areas of food insecurity, as concluded by Christian et al ().…”

Effectiveness of Ready-to-Use Therapeutic Food Among Children With Protein-Calorie Malnutrition

“…Malnourished children frequently look very thin or wasted with malnourishment being a common cause of morbidity and mortality among pediatric age groups [ 14 , 15 ]. In resource constraint healthcare settings, treatment of malnourishment is not always attainable due to practical reasons while a home-based therapeutic approach is commonly considered a better option for these children.…”

A Model for Improved Estimates of Child Wasting in Yemen: Capturing the Effects of Conflict and Seasonal Variability In Incidence Estimates

“…[13]. In the absence of spontaneous recovery estimates speci c to Yemen -and due to a general scarcity of reporting of spontaneous recovery of wasting -rates of spontaneous recovery for moderate wasting were estimated using data from a cohort study following moderately wasted under-ve children in Iran [14]. Though the contexts of Iran and Yemen differ in several ways, this estimate was taken among the limited available estimates as the most comparable to Yemen.…”