The management of moderate acute malnutrition in children aged 6-59 months in low- and middle-income countries: a systematic review and meta-analysis

Abstract

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.

Systematic Review of Management of Moderate Wasting in Children over 6 Months of Age

“…Furthermore, the authors highlighted the potential to enhance the effectiveness by focusing on improving the quality and adherence to counseling interventions. A more recent systematic review by Gluning et al (2021) also found that children had a greater likelihood of recovery if they received a specially formulated food than if they did not [33].…”

Serum insulin-like growth factor 1 in young children with moderate acute malnutrition: secondary analysis of a randomized trial in Burkina Faso

“…Several studies have evaluated the effects of the supplement matrix or different protein sources on recovery from MAM and growth. Reviews and meta-analyses have often found superior recovery among children treated with LNS vs FBF [4][5][6][7]. Some reviews found higher gain in weight, weight-for-height z-score (WHZ), or MUAC [5][6][7][8], but not height [8] when children with MAM were treated with LNS compared to CSB.…”

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

“…Considerable discrepancies exist between the treatment protocols in different countries (14)(15)(16)(17)(18). MAM protocols may implement readyto-use supplementary food (RUSF), fortified flours, nutrition education or counselling to improve child's nutritional status (19,20). Differences also exist in the cut-off points of the anthropometric indicators mid-upper arm circumference (MUAC) and/or weight-forheight Z-score (WHZ) that determine admission and cure.…”