Standard RUTF vs. locally-made RUSF for acutely malnourished children: A quasi-experimental comparison of the impact on growth and compliance in a rural community of Pakistan

Sarfraz, Azza; Ahmed, Sheraz; Sajid, Muhammad; Rehman, Najeeb Ur; Soomro, Sanam Iram; Qureshi, Kashif; Jakhro, Sadaf; Umrani, Fayaz; Greene, Adam; Syed, Sana; Moore, Sean R.; Ali, Syed Asad

doi:10.1371/journal.pone.0287962

Cited by 3 publications

(1 citation statement)

References 26 publications

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“…3 and 4 ) seem to suggest a different representation of the results for weight gain, WHZ/WLZ in children aged between 6 and 35 months compared to those aged between 6 and 59 months old. Although the impact of RUSF seems larger in younger children for these outcomes, which has been confirmed in infants, ( 52 ) too few studies are available to draw any conclusions about the impact of age on the effect of RUSF. Overall, the included studies posed a high risk of bias.…”

Section: Discussionmentioning

confidence: 94%

Current evidence on the effectiveness of Ready-to-Use Supplementary Foods in children with moderate acute malnutrition: a systematic review and meta-analysis

Teshome,

Lema,

Abessa

et al. 2023

J Nutr Sci

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Moderate acute malnutrition (MAM) is defined by a weight-for-height Z-score (WHZ) between −3 and −2 of the WHO reference or by a mid-upper arm circumference (MUAC) of ≥11⋅5 and <12⋅5 cm. This study aimed to synthesise the evidence for the effectiveness of Ready-to-Use Supplementary Food (RUSF) compared to other dietary interventions or no intervention on functioning at different levels of the International Classification of Functioning, Disability, and Health (ICF) among children with MAM between 2 and12 years old. Three databases (PubMed, Scopus, and Web of Science) were systematically searched (last update: 20 November 2022). Pooled estimates of effect were calculated using random-effects meta-analyses. The level of evidence was estimated with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method. Seven studies were included. RUSF had a significant small-sized better effect (pooled mean: 0⋅38; 95 % CI = [0⋅10, 0⋅67], P = 0⋅01, I² = 97 %) on different anthropometric measurements compared to other dietary interventions among MAM children (n 6476). Comparing RUSF with corn–soy blend Plus Plus (CSB++) showed that RUSF had a small-sized but significantly better effect on the children's anthropometric measures compared to children who received CSB++ (pooled mean: 0⋅16; 95 % CI = [0⋅05, 0⋅27], P = 0⋅01; I2 = 35 %). MAM children treated with RUSF had a better recovery rate compared to those treated with CSB++ (pooled risk difference: 0⋅11; 95 % CI = [0⋅06, 0⋅11], P < 0⋅001; I2 = 0 %). The RUSF intervention seems promising in improving MAM children's nutritional outcomes and recovery rate compared to other dietary interventions.

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Section: Discussionmentioning

confidence: 94%

Current evidence on the effectiveness of Ready-to-Use Supplementary Foods in children with moderate acute malnutrition: a systematic review and meta-analysis

Teshome,

Lema,

Abessa

et al. 2023

J Nutr Sci

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Epidemiology and clinical characteristics of acute malnutrition among under-5 children attending a rural hospital in the Democratic Republic of Congo: a cross-sectional study

Bavurhe,

Ahmad,

Naaz

et al. 2024

Annals of Medicine &Amp; Surgery

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Background: Malnutrition, a public health problem in a low-income country such as the Democratic Republic of Congo (DR Congo), is a major killer among children under 5 who are most at risk of acute malnutrition. This study aims to describe the epidemiological and clinical characteristics of acute malnutrition in children under 5 years old. Methods: We conducted a retrospective and descriptive cross-sectional study on children under 5 with acute malnutrition from April 2022 to April 2023. A total of 287 malnourished children were consulted, hospitalized in a rural hospital, and registered for participation in this study. Results: 287 (25%) children were victims of acute malnutrition. The age group between 13 and 24 months is the most affected by acute malnutrition with 30%. The male-to-female(M/F) sex ratio was 1.17. Kwashiorkor is the most common form of acute malnutrition with 171 (59.6%) cases. Abdominal bloating, weight loss as well as diarrhea and vomiting were the more frequent clinical signs. Shock is the most complication of acute malnutrition. Therapeutic milk (Food 75 and Food 100) was the most effective in management. 29 (10.1%) other children died from acute malnutrition and 258 (89.9%) children progressed to full recovery. Conclusion: Acute malnutrition in children remains a public health problem worldwide and particularly in low-income countries such as DR Congo. It is associated with multiple physiological vulnerabilities and has many short- and long-term complications in children who have suffered from it.

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A shared group of bacterial taxa in the duodenal microbiota of undernourished Pakistani children with environmental enteric dysfunction

Iqbal,

Chen,

Griffin

et al. 2024

mSphere

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Environmental enteric dysfunction (EED) is a subclinical syndrome of altered small intestinal function postulated to be an important contributor to childhood undernutrition. The role of small intestinal bacterial communities in the pathophysiology of EED is poorly defined due to a paucity of studies where there has been a direct collection of small intestinal samples from undernourished children. Sixty-three members of a Pakistani cohort identified as being acutely malnourished between 3 and 6 months of age and whose wasting (weight-for-length Z -score [WLZ]) failed to improve after a 2-month nutritional intervention underwent esophagogastroduodenoscopy (EGD). Paired duodenal luminal aspirates and duodenal mucosal biopsies were obtained from 43 children. Duodenal microbiota composition was characterized by sequencing bacterial 16S rRNA gene amplicons. Levels of bacterial taxa (amplicon sequence variants [ASVs]) were referenced to anthropometric indices, histopathologic severity in biopsies, expression of selected genes in the duodenal mucosa, and fecal levels of an immunoinflammatory biomarker (lipocalin-2). A “core” group of eight bacterial ASVs was present in the duodenal samples of 69% of participants. Streptococcus anginosus was the most prevalent, followed by Streptococcus sp., Gemella haemolysans , Streptococcus australis , Granulicatella elegans , Granulicatella adiacens, and Abiotrophia defectiva . At the time of EGD, none of the core taxa were significantly correlated with WLZ. Statistically significant correlations were documented between the abundances of Granulicatella elegans and Granulicatella adiacens and the expression of duodenal mucosal genes involved in immune responses (dual oxidase maturation factor 2, serum amyloid A, and granzyme H). These results suggest that a potential role for members of the oral microbiota in pathogenesis, notably Streptococcus , Gemella, and Granulicatella species, warrants further investigation. IMPORTANCE Undernutrition among women and children is a pressing global health problem. Environmental enteric dysfunction (EED) is a disease of the small intestine (SI) associated with impaired gut mucosal barrier function and reduced capacity for nutrient absorption. The cause of EED is ill-defined. One emerging hypothesis is that alterations in the SI microbiota contribute to EED. We performed a culture-independent analysis of the SI microbiota of a cohort of Pakistani children with undernutrition who had failed a standard nutritional intervention, underwent upper gastrointestinal tract endoscopy, and had histologic evidence of EED in their duodenal mucosal biopsies. The results revealed a shared group of bacterial taxa in their duodenums whose absolute abundances were correlated with levels of the expression of genes in the duodenal mucosa that are involved in inflammatory responses. A number of these bacterial taxa are more typically found in the oral microbiota, a finding that has potential physiologic and therapeutic implications.

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Standard RUTF vs. locally-made RUSF for acutely malnourished children: A quasi-experimental comparison of the impact on growth and compliance in a rural community of Pakistan

Cited by 3 publications

References 26 publications

Current evidence on the effectiveness of Ready-to-Use Supplementary Foods in children with moderate acute malnutrition: a systematic review and meta-analysis

Current evidence on the effectiveness of Ready-to-Use Supplementary Foods in children with moderate acute malnutrition: a systematic review and meta-analysis

Epidemiology and clinical characteristics of acute malnutrition among under-5 children attending a rural hospital in the Democratic Republic of Congo: a cross-sectional study

A shared group of bacterial taxa in the duodenal microbiota of undernourished Pakistani children with environmental enteric dysfunction

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